MINUTES OF THE meeting
of the
ASSEMBLY Committee on Health and Human Services
Seventy-Second Session
March 24, 2003
The Committee on Health and Human Serviceswas called to order at 1:57 p.m., on Monday, March 24, 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:
Ms. Genie Ohrenschall, Clark County District No. 12
STAFF MEMBERS PRESENT:
Marla McDade Williams, Committee Policy Analyst
Terry Horgan, Committee Secretary
OTHERS PRESENT:
Steven Phillips, M.D., C.M.D., Director, Office of Geriatric Medicine, University of Nevada, Reno; Chairman, Health Care Systems Committee, American Geriatrics Society
Mary Liveratti, Deputy Director, Department of Human Resources
Robert McCune, President, Nevada Silver Haired Legislative Forum
Larry Spitler, Associate State Director for Advocacy, American Association of Retired Persons, Nevada
Mark Nichols, Executive Director, National Association of Social Workers, Nevada Chapter
Fred Hillerby, Washoe Health Systems, Washoe Medical Center
Rose Tuana, Executive Director, Board of Examiners for Social Workers
Don Williams, Chief Principal Research Analyst, Research Division, Legislative Counsel Bureau
Launa Hall, University of Nevada, Las Vegas, Student
Mike Bernstein, Health Educator, Clark County Health District
Lynn Carrigan, Administrator, Nevada Public Health Foundation
Bonnie Parnell, Nevada Parent-Teacher Association
Chairwoman Koivisto opened the meeting by introducing Assemblywoman Ohrenschall, sponsor of A.B. 349.
Assembly Bill 349: Makes various changes concerning older Nevadans. (BDR 38-973)
Assemblywoman Genie Ohrenschall, Clark County District No. 12, explained that A.B. 349 dealt with senior citizens and the people who provided them with medical and other services. The bill would mandate that those providers have some knowledge of geriatrics and gerontology, so a portion of continuing education requirements for licensure would have to include geriatrics. In addition, A.B. 349 would remove the limitation on the number of meetings the Nevada Silver Haired Legislative Forum could hold.
Steven Phillips, M.D., C.M.D., Director, Office of Geriatric Medicine, University of Nevada School of Medicine; Chair, Health Care Systems Committee, American Geriatrics Society, read from his prepared text in support of A.B. 349 (Exhibit C). Dr. Phillips stated that Nevada’s senior population was growing rapidly and by 2015 would represent 20 percent of all Nevadans and require nearly half of all health care dollars. He indicated that physicians and other health care professionals who understood the medical, psychological, functional, and social aspects of aging would be better prepared to meet the current and future challenges facing the state. Dr. Phillips noted that the fields of geriatrics and gerontology focused on the whole person by dealing with multiple, complex, and interrelated conditions that could ultimately result in functional decline and the loss of independence. He added that the cost of health care for an aging society could be viewed as being inversely proportional to functional status.
Dr. Phillips emphasized the need for certain professional schools, such as nursing, medicine, dentistry, pharmacy, social work, and medicine, to provide basic educational curricula that covered the aging process. He noted that development of courses addressing the fields of geriatrics and gerontology would be needed but believed that mandating education and training would ensure a supply of current and future health care professionals with a basic understanding of elderly clients.
Assemblywoman Angle, referring to the section in A.B. 349 concerning the Nevada Silver Haired Legislative Forum, inquired how the bill would change the way they conducted their business.
Assemblywoman Ohrenschall explained that passage of A.B. 349 would allow the Nevada Silver Haired Legislative Forum to meet as often as necessary to conduct its business when the Legislature was in session, as long as they complied with the provisions of Chapter 241 of the Nevada Revised Statutes (NRS). She indicated that the limited number of bill drafts available had resulted in her putting two concepts in the same bill.
Mrs. Angle said that she had wanted to be certain that the Nevada Silver Haired Legislative Forum and the continuing education were not related.
Ms. Ohrenschall replied that the Nevada Silver Haired Legislative Forum had been the first to look into the need for the continuing education. She added that her family discovered too late that when an older woman suddenly developed a “pot belly” it could be a sign of trouble. In the case of Ms. Ohrenschall’s mother, it was congestive heart failure, but no physician had communicated with the family and explained the danger signs.
Assemblyman Horne, referring to the training for people working in licensed facilities, asked whether the training would be transferable. He expressed concern that as a worker moved from one job to another, that worker might be required to go through training again.
Ms. Ohrenschall agreed that retraining would not make any sense and asked Mary Liveratti to come forward and provide advice.
Mary Liveratti, Deputy Director, Department of Human Resources, explained that each licensure board set regulations for overseeing licensees and that each discipline had its own licensing board. Referring to people who were unlicensed, she indicated those people might be included in the facility’s license.
Assemblywoman Ohrenschall replied that long-term care facilities were very careful whom they hired and had to post bonds. She mentioned that there were additional witnesses in southern Nevada who wanted to speak.
Assemblyman Horne said that he was concerned with the cost issue. He noted that the people would not be licensed, but that they still had to receive training. He inquired how costly the training would be.
Ms. Ohrenschall answered that her experience with homes that provided care was that they tended to be family-run businesses with at least one member of the family being a licensed nurse.
Assemblyman Mabey, stating that he was an obstetrician/gynecologist (OB/GYN), asked whether 10 percent of that curriculum would need to be in geriatrics.
Dr. Phillips stated it was nationally recognized that OB/GYN was a primary care specialty. He added that, with the requirement of 40 hours of continuing education every two years, for 10 percent, or 4 of those hours, to be within the field of geriatrics, was not unreasonable. Referring to pediatrics, he thought there might be exclusions based upon the area of specialty.
Mr. Mabey explained that to get certification every program had national guidelines, and if Nevada mandated that 10 percent of the training be in geriatrics, that might be a burden.
Dr. Phillips stated that he had just completed a four-year curriculum development as part of the Nevada School of Medicine and that, because of the overall training in hospital and community medicine, more than 10 percent of the patients seen would be of Medicare age.
Ms. Ohrenschall noted that perimenopause, and the issue of whether to prescribe hormone replacement therapy, could begin as early as age 30. She agreed that there probably would be areas of health care that would not treat senior citizens, and if the Committee wanted an amendment to eliminate those people, she would go along with the idea.
Assemblywoman McClain thanked Ms. Ohrenschall for sponsoring A.B. 349. She believed the timing was right and she approved of the approach in the bill. She emphasized that everyone should be taking courses in geriatrics and gerontology because everyone dealt with senior citizens at one time or another in their lives. She indicated that there had also been a bill drafted this session dealing with dementia and the people who cared for them.
Assemblywoman Ohrenschall responded that no one wanted to think their own parents might become victims of dementia. She added that it would really help if the family doctor would warn family members to “keep their eyes open.”
Assemblyman Hardy commented that “the concept was laudable,” but he wanted to know whether the health care worker needed to be trained before being hired, or whether there would be a period of time after hiring during which that person could receive training, and whether the janitor, administrator, or accountant of the facility would also need training. Noting that he was a physician in family practice, Mr. Hardy mentioned that a requirement to maintain a Nevada license already existed in continuing medical education for two credits in ethics. He asked how the training would be tracked, about the “pseudo-licensure” of the people working in the periphery of health care facilities, and also who would pay for the training.
Referring to the Nevada Silver Haired Legislative Forum, Mr. Hardy asked if Chapter 241 in NRS concerned Nevada’s open meeting laws, and if passage of the bill would affect posting notices of meetings.
Ms. Ohrenschall answered that the Forum was subject to the open meeting laws. She reiterated that what the Forum wanted was the ability to respond to something that might be going on in the Legislature while there would still be time to amend or address the issue.
Mr. Hardy stated that if the open meeting law were a local jurisdiction open meeting law, there was a five-day period for posting notice of the meeting in all the places notices were required to be posted, and he commented that, given the speed with which the Legislature moved, those laws would certainly be violated. He noted that Ms. Ohrenschall might look at the language involved with “working groups” that could meet without violating the open meeting law.
Robert McCune, President, Nevada Silver Haired Legislative Forum, explained that the Forum was a statutory committee created by legislative act in the 2001 Legislative Session. All meetings, he added, were conducted under the “overview” of the Legislative Counsel Bureau.
Mr. McCune stated that the Nevada Silver Haired Legislative Forum held three hearings, condensed their findings during a meeting, and in January 2002, had submitted a report, Legislative Counsel Bureau Report No. 18. Mr. McCune indicated that 2 of the 22 recommendations in their report were contained within A.B. 349. He added that the Nevada Silver Haired Legislative Forum had also hoped courses in geriatrics could be made available to non-medical personnel, who made up a large portion of the work force in health care facilities. Mr. McCune expressed the hope that the Nevada Silver Haired Legislative Forum’s recommendations not get “put on a shelf.” He also pointed out that the Nevada Silver Haired Legislative Forum was self-sustaining.
Larry Spitler, Associate State Director of Advocacy, American Association of Retired Persons (AARP), explained that AARP was a non-profit, non-partisan membership organization dedicated to making life better for people aged 50 and over. They provided their members with information and resources, engaged in legislative, regulatory, and legal advocacy, assisted members in serving their communities, and offered a wide range of benefits, special products, and services. Mr. Spitler noted that there were over 258,000 members of AARP in Nevada and that AARP supported A.B. 349 (Exhibit D) because the United States lacked a comprehensive long-term care system. He believed it was the responsibility of federal and state governments to ensure delivery of quality long-term care, and that quality assurance systems for nursing homes and home and community-based services should be vigorously enforced. Mr. Spitler stated that A.B. 349 was a good beginning toward ensuring proper care for elderly Nevadans who had to trust the skills of their caregivers.
Mark Nichols, Executive Director, National Association of Social Workers, Nevada Chapter, expressed opposition to A.B. 349 as it related to social workers and the need for initial or ongoing training. Social workers, he noted, received training that included gerontology and were currently required to have 30 continuing education units (CEUs) every 2 years in order to renew their licensure. He mentioned that two of those credits were required to be in the field of ethics, which already caused logistical problems for some people. The addition of more criteria on a subject that might or might not be in the social worker’s field of practice would only exacerbate the logistical problem, Mr. Nichols emphasized. He stated that social workers practiced within their areas of competency and quoted from their code of ethics, “A social worker should accept responsibility or employment only on the basis of existing competency or intention to acquire the necessary competency.” Mr. Nichols reiterated that, if a social worker did not have expertise in the area of gerontology and was offered a position, it would be incumbent upon that social worker to acquire the appropriate training.
Assemblywoman McClain pointed out that page 2, line 5, of A.B. 349 stated training was needed if 50 percent or more of a person’s practice included older persons. Otherwise only 10 percent of the continuing education needed to be in geriatrics, she said, and asked if that solved Mr. Nichols’ problems. Ms. McClain pointed out that, even though the social workers’ code of ethics indicated the social worker “should” accept responsibility and get trained, there was no guarantee that they would.
Mr. Nichols replied that if the social worker was not trained, and refused to go through the training, the social worker would be subject to disciplinary action by the Board of Examiners for Social Workers.
Ms. McClain replied that she was confused about why continuing education focused on geriatrics would be a burden to social workers, when language in A.B. 349 linked the amount of time spent caring for senior citizens to the percentage of continuing education needed on the subject. She added that if one were only working with children, A.B. 349 would not apply. Ms. McClain corrected herself, stating that one would need geriatrics training in 10 percent of the continuing education required for licensure, but that everyone should have that training anyway.
Chairwoman Koivisto indicated that she was concerned because it appeared as though A.B. 349 was “painting with a really broad brush.” She stated that it appeared as though everyone working in a long-term care facility or providing any kind of care needed to have “this training,” and indicated concern about the availability of the training for nurses’ aides, certified nursing assistants, and others. Mrs. Koivisto noted that the bill’s effective date was July 1, 2003, and that people would suddenly find themselves not qualified for the jobs they were doing on that date. She asked how that would be dealt with.
Dr. Phillips replied that the fields of medicine all had ethics requirements that usually dealt with dementia, end-of-life care, palliative care, and ethical decision-making. He added that the opportunity to identify those social workers who might be excluded from A.B. 349 could be considered.
Referring to training and oversight, Dr. Phillips stated that there were state and federal requirements for nursing facilities and that those facilities had built-in education directors and were offering courses to nurses, certified nursing assistants, and therapists. Dr. Phillips commented that janitors and administrators would not be a population of employees one would give in-depth aging or functional presentations to; however, he noted that exposure to sensitivity training would “go a long way within those professions.” Group care homes and assisted living facilities that wished to distinguish themselves were already doing ongoing training of staff, Dr. Phillips indicated. Speaking of the July 1, 2003, date being a little ambitious, he agreed that in some areas it might be a little unrealistic.
Assemblywoman McClain interjected that the Aging Services Directors Organization held an annual caregivers symposium, which was an all-day workshop for people who ran group homes or cared for their own elderly. The symposium offered continuing education units, she emphasized.
Assemblywoman Ohrenschall added that she had seen family members who frequently did not understand dementia or other senior healthcare problems.
Assemblyman Hardy stated that there was currently a 40-hour continuing education requirement to keep his license in Nevada, but that the Academy of Family Practice requirement was 50 hours annually, or a cumulative 150 hours in a three-year period. Noting that he was a family practice physician with a majority of elderly patients, he asked if he would now be required to have 10 hours of designated geriatric and aging process continuing medical education annually. Mr. Hardy also asked at what age one would be considered “elderly.”
Dr. Phillips said it was his interpretation that the requirements were “at licensure,” which was every two years in Nevada. He needed 40 hours of continuing medical education with 2 of the hours in the field of ethics, and that there could be some overlap. For instance, he noted, if dementia was being studied in the ethics portion, that would be a geriatrics topic. Dr. Phillips added that he considered “elderly” to be over the age of 65.
Mr. Hardy commented that he was glad Dr. Phillips had said “overlap” because he could not attend a medical conference in family practice without having some aging process or geriatric involvement and that it would be very difficult not to get exposed to those credits. He noted, however, that the exact geriatric portion of the courses was generally not “broken out.” Would those credits be reported on the “honor system,” he inquired.
Dr. Phillips answered that Nevada, for the first time, was requesting a hard copy of all his continuing medical education class credit information, so the majority of physicians had been on the honor system. He agreed that ethics education had overlap and he indicated that, if a class had components covering the topic of aging, the person could take geriatric credit for those hours. Dr. Phillips mentioned that there was an annual 10-hour conference on primary care and geriatrics held in Las Vegas.
Assemblywoman Ohrenschall explained that the reason she was asking physicians and others to be more aware of geriatrics and gerontology was because they were trusted so much.
Assemblywoman McClain indicated that “older persons” might not need defining.
Ms. Ohrenschall said that she would leave the age up to the Committee.
Chairwoman Koivisto commented that the legal definition, for purposes of crimes against the elderly, was 60 years of age.
Ms. Ohrenschall noted that the Legislative Counsel Bureau took the position that if an age or status were defined in one part of NRS, that definition automatically held for the rest of NRS, and it might not be necessary to repeat the definition.
Fred Hillerby, representing Washoe Health Systems, Nevada State Board of Nursing, Nevada State Board of Dental Examiners, and the Nevada State Board of Pharmacy, referred to line 4 of A.B. 349, which spoke of obtaining licensure. Mr. Hillerby said with that particular provision in statute, people would try to hire someone who was a graduate of an accredited school. None of the Boards he represented would examine the curriculum of a school to see if it met the provisions in subsection 2 of A.B. 349, he noted. Referring to people who did not need licensure, such as those in housekeeping and dietary, Mr. Hillerby indicated that the expectation that a facility could guarantee their educations as defined in subparagraph 2 was probably not realistic.
Mr. Hillerby, speaking generally about education, noted that there had been a tendency by the Legislature not to designate specific numbers of hours for specific types of treatment or care, because those could “ebb and flow” and then it became difficult to address new areas of interest.
Rose Tuana, Executive Director, State of Nevada Board of Examiners for Social Workers, expressed the Board’s opposition to A.B. 349 and indicated she supported Mr. Hillerby’s comments. She pointed out that not all social workers were healthcare providers and that to have them be required to take the coursework when they were not even in the field would be inappropriate. Ms. Tuana noted that much of the concern appeared to be about people who were not licensed. She added that professionals working in the field took their continuing education in the area they were working.
Ms. Tuana, quoting from the Code of Ethics for social workers, read “it is a requirement to have competency in the area one is practicing in.” She emphasized that one would be subject to disciplinary action if one were not competent.
Ms. Tuana asked if there were any fiscal notes for the Health Division because even though they were not included, it would put an extra burden on the boards to track this continuing education. She acknowledged that there had been little geriatric continuing education available, but noted that recently there had been a number of good courses, mainly from the University of Nevada School of Medicine.
Chairwoman Koivisto requested Ms. Tuana and Mr. Hillerby get together with Ms. Ohrenschall to address the questions that had arisen, so that action on the bill could proceed.
Assemblywoman Ohrenschall, referring to Mr. Hillerby’s comment about conditions for obtaining or renewing a license, stated that she viewed it as nothing more than any professional job where, when one made application, one agreed in advance to follow all the rules and regulations of the licensing authority.
Chairwoman Koivisto thanked Ms. Ohrenschall and requested she work with Mr. Hillerby and Ms. Tuana and return by the next week.
Chairwoman Koivisto requested that Ms. Leslie and Mr. Williams present the three S.C.R.s.
Senate Concurrent Resolution 3: Urges each community in Nevada to form coalition of agencies and service providers to reduce number of suicides and provide support for survivors. (BDR R-291)
Senate Concurrent Resolution 4: Urges Clark County Health District to plan and coordinate public information campaign relating to suicide prevention and expand injury prevention efforts in Clark County. (BDR R-290)
Senate Concurrent Resolution 5: Urges agencies in Clark County to cooperate in establishment of plan for suicide prevention in Clark County. (BDR R-289)
Assemblywoman Sheila Leslie, Washoe County District No. 27, explained she was appearing on behalf of Senator Ann O’Connell, Chairwoman of the Legislative Commission’s Subcommittee to Study Suicide Prevention. Ms. Leslie stated that she had served on the Committee, and that the results of the Study had been distributed (Exhibit E).
All three resolutions, Ms. Leslie noted, had come out of the interim committee, which had met five times during the interim. She pointed out that Nevada had the second highest rate of suicide among the 50 states. Suicide was the fifth leading cause of death among Nevadans, Assemblywoman Leslie noted, and was evident among all age groups and socio-economic populations.
Ms. Leslie mentioned that a Senate bill to develop a statewide suicide prevention plan, plus funding for a statewide coordinator and other staff positions, might be coming to the Assembly this session.
Ms. Leslie explained that S.C.R. 3 urged each community to form a coalition of agencies and service providers to reduce the number of suicides and provide support for survivors. The resolution cited the National Strategy Prevention: Goals and Objectives for Action and included recommendations for integrating suicide prevention into existing programs, developing comprehensive plans for suicide prevention that coordinated across governmental agencies and the private sector, and enhancing public awareness through coordination and communication, especially in Clark County and the rural counties, which did not have crisis call centers as Reno did.
Ms. Leslie noted that S.C.R. 4 urged the Clark County Health District to plan and coordinate a public information campaign on suicide prevention and to expand injury prevention efforts. This resolution cited the Surgeon General’s call to action to prevent suicide in the national public health agenda, Healthy People, as a guide. Ms. Leslie explained that, because Clark County contained nearly 70 percent of the population in Nevada and had the majority of deaths by suicide, the resolution asked for a plan for coordination of a public information campaign and an expansion of injury prevention efforts. It encouraged Clark County to establish a project called “Healthy Clark County 2010,” which would follow national recommendations.
Assemblywoman Leslie indicated that S.C.R. 5 urged agencies in Clark County to cooperate in establishment of a plan for suicide prevention. It also expressed concern that, over the last five years, 64 percent of the completed suicides had occurred in Clark County and that a survey had revealed a substantial lack of programs on suicide prevention. It indicated a greater need for coordination and communications among existing agencies, and had a number of specific suggestions for how Clark County could develop a suicide prevention plan. Ms. Leslie added that S.C.R. 5 also asked that the suicide prevention message be transmitted to Nevada’s local leaders.
Ms. Leslie explained that the Committee heard a lot of testimony from youth, from citizens in Douglas County who had already mounted a “yellow ribbon” campaign, from service providers, and from the general community about how important it was for Nevada to focus on the problem and, hopefully, reduce its suicide statistics.
Don Williams, Chief Principal Research Analyst, Legislative Counsel Bureau, explained that he was not present to either support or oppose the legislation, but simply to provide information to the Committee (Exhibit F).
Assemblyman Mabey asked Assemblywoman Leslie if she had an opinion about why the West had higher suicide rates than other areas of the country.
Ms. Leslie commented that the Western states seemed to have a “libertarian” attitude. Westerners took care of themselves and did not like to ask for help, she explained. Ms. Leslie also noted that Nevada’s social services safety net was very thin, so there were not a lot of prevention programs in place. In addition, a number of the people who had moved to Nevada had left their families behind, so that type of support would no longer be available. She mentioned that some people moved to Nevada looking for a second or third chance, and that the state’s “alcohol, gaming, and drug culture,” coupled with people who might have been “fragile” when they moved here, contributed to the problem.
Mr. Williams mentioned that, looking at other states’ statistics, he had been surprised that some Eastern states he assumed might have mental health problems because of congestion or other factors had some of the lowest rates. He pointed out that New Jersey, which also had gaming, had one of the lower suicide rates. Mr. Williams commented that areas with a lot of community connections, community networks, and families, tended to have lower suicide rates. He added that he believed there were a multitude of factors involved.
Assemblywoman Angle told Committee members that 35 years ago she had started a crisis hot line for children in White Pine County. She noted that “clusters” seemed to occur whereby one child would commit suicide, it would become a fad, and others would copy it. Mrs. Angle asked if that phenomenon had been noted.
Ms. Leslie replied that there had been some testimony about clusters but that the Committee had not specifically developed a recommendation around that issue. She indicated a belief that clusters might be under-reported. Ms. Leslie noted that there were some excellent suicide prevention programs currently operating in the schools; however, she noted that the people operating the programs had to be invited into the schools because there was nothing in the curriculum. She also mentioned that there was no mandate to provide suicide prevention training for teachers, and suggested that the entire topic of youth suicide prevention had not been adequately covered in the recommendations from the interim Committee.
Mr. Williams explained that a proposed Senate bill would create a statewide suicide prevention program that would work with the communities and collect better data, which would, hopefully, address the issue of clusters.
Assemblywoman Angle stated that in Nye County the children contracted together in suicide compacts. She added that it had also been noted that the more suicide was talked about, the more it became a problem, and she asked if the interim Committee had found a way to address the problem without glorifying it.
Assemblywoman Leslie answered that the research she had seen had not indicated that talking about suicide made youth suicide occur more often. She added that the issue of glorifying suicide in the media and dealing with the emotions that surrounded a youth suicide were what needed attention.
Mr. Williams added that the advocates of suicide prevention, including family members and parents of victims, had consistently told the Committee that it was a myth that just because children became aware of it, that they would commit suicide.
Assemblyman Hardy, saying that he was an expert, stated that as a medical model, suicide usually followed depression. He noted that the resolutions before the Committee addressed suicide prevention and therefore would have to include that safety net, described by Ms. Leslie, which would allow for mental health access. Mr. Hardy emphasized that the “rurals” did not have mental health access, and added that, even if there were mental health access, the client would have to admit, possibly to someone they knew well, that they were accessing that facility for “depression, mental health,” or whatever derogatory terms might be used. Mr. Hardy added that it was amazing to see what could happen through “the miracle” of non-addicting, non-habit-forming medicines that treated depression. He noted that if a suicidal person were treated for depression, at least 80 percent of the time, that person would get better within a month or six weeks. People suffering from depression, Mr. Hardy added, did not have the ability to make decisions. Early intervention to treat biochemical depression was vital, he emphasized, so mental health access all across Nevada was crucial.
Assemblywoman Leslie expressed her support for Assemblyman Hardy’s preceding statements. She also indicated a need for more creativity when addressing mental health needs in the rural areas of Nevada, as well as a need to make accessing those services more acceptable. To that end, she suggested school-based health clinics.
Launa Hall, University of Nevada, Las Vegas, social work student, spoke in support of S.C.R. 3. She explained that, as a student, she had learned of the very important roles played by education, awareness, and resources in reducing Nevada’s suicide rates. Ms. Hall explained that S.C.R. 3 represented a conscientious effort to recognize the problem of suicide in Nevada and how far- reaching it was. She also wanted the record to reflect her support of S.C.R. 4 and S.C.R. 5.
Mike Bernstein, Health Educator, Clark County Health District, stated that he worked in the area of injury and suicide prevention and that in 1990 Clark County had started developing year 2010 goals in the area of injury prevention. During discussions surrounding the issue, two areas of concern were noted, one being drowning prevention and the other being suicide prevention. Mr. Bernstein explained that Clark County was trying to become pro-active and increase community awareness of the problem. In late April, he noted, Clark County would proceed with a suicide awareness project that would focus on making Clark County citizens aware that suicide was preventable, was a public health problem, and that there was help available.
The campaign in Clark County, Mr. Bernstein noted, would involve bus stop shelters, ten-second radio ads advertising the toll-free suicide hot line, and a Web site was in development. Mr. Bernstein explained that teens did not call suicide hot lines, and that it had been thought they might more readily use a Web site.
Lynn Carrigan, Administrator, Nevada Public Health Foundation, spoke in support of S.C.R. 3 (Exhibit G). Ms. Carrigan explained that on December 13, 2002, and January 31, 2003, the Nevada Public Health Foundation and the Office of Rural Health had conducted suicide dialogues with 14 Nevada communities. The focus of the meetings was on discussing the suicide problem, current suicide resources available, and the need for resources in rural Nevada. She noted that the need for suicide prevention services in rural Nevada was profound and especially so with respect to the youth. Ms. Carrigan explained people did not know what to do when there had been a suicide: should they speak to their children or not, who should do the talking, and what should they say. There were no suicide prevention resources in rural Nevada, with the exception of Douglas County, except those provided through Nevada rural clinics, she noted.
Ms. Carrigan commented that over 70 percent of the people who were depressed never sought treatment for depression, so a broader scope of services was needed. She added that the suicide problem would not be solved if reliance were strictly on mental health services.
Ms. Carrigan emphasized that the rural areas needed “everything,” adding that there was too little prevention and no support for families and friends when a suicide did occur. Coalitions in rural communities were an ideal way to begin to address this issue in rural Nevada, she noted, because coalitions could bring community involvement, and also set local priorities for the development of suicide prevention services.
Ms. Carrigan expressed strong support for the sentiment expressed by S.C.R. 3 and encouraged its adoption.
Bonnie Parnell, Nevada Parent-Teachers Association (PTA), explained that the Nevada PTA was one of the groups that would be involved as part of the community support outlined in the resolution. She mentioned the importance of integrating existing programs and activities to bring together people who had concerns. She added that the Nevada PTA might be able to address concerns about youth suicide and emphasized how important warning signs were. As parents, teachers, and athletic coaches, Ms. Parnell explained that most adults probably did not know what to look for, what the warning signs were. She emphasized that workshops at PTA conventions or teacher in-service training might provide direction. In conclusion, Ms. Parnell stated that the Nevada PTA was in support of S.C.R. 3.
With no one else wishing to speak, Chairwoman Koivisto brought the three Senate Concurrent Resolutions back to the Committee for action.
ASSEMBLYWOMAN LESLIE MOVED FOR COMMITTEE ADOPTION OF S.C.R. 3, S.C.R. 4, AND S.C.R. 5.
ASSEMBLYWOMAN McCLAIN SECONDED THE MOTION.
THE MOTION PASSED UNANIMOUSLY.
Chairwoman Koivisto reminded Committee members that the meeting on March 31 would start at 1:00 p.m. and that it was likely the meeting on April 2 would as well. With no further business to come before the Committee, the meeting was adjourned at 3:41 p.m.
Terry Horgan
Committee Secretary
APPROVED BY:
Assemblywoman Ellen Koivisto, Chairwoman
DATE: