MINUTES OF THE meeting
of the
ASSEMBLY Committee on Health and Human Services
Seventy-Second Session
May 12, 2003
The Committee on Health and Human Serviceswas called to order at 1:43 p.m., on Monday, May 12, 2003. Chairwoman Ellen Koivisto presided in Room 3138 of the Legislative Building, Carson City, 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.
Note: These minutes are compiled in the modified verbatim style. Bracketed material indicates language used to clarify and further describe testimony. Actions of the Committee are presented in the traditional legislative style.
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:
Jane Smedes, Management Analyst, Department of Human Resources
Mike Willden, Director, Department of Human Resources
Randall Todd, Ph.D., State Epidemiologist, Health Division, Department of Human Resources
Janine Hansen, President, Nevada Eagle Forum
Chairwoman Koivisto:
The Committee on Health and Human Services will come to order, please. [Roll was called.] Please mark all members present when they arrive.
Today we are going to hear S.B. 459, which makes changes to Senior Rx.
Senate Bill 459: Revises amount of limit on income of senior citizens to qualify for subsidy for prescription drugs or pharmaceutical services from money in Fund for a Healthy Nevada. (BDR 40-1247)
Jane Smedes, Management Analyst, Department of Human Resources:
[Introduced herself.] We are here to support S.B. 459 which would make changes to the Senior Rx program. S.B. 459 was requested by the Department of Human Resources.
In Section 1, there is a technical change to the language from “purchase” to “is eligible for a policy of health insurance.” The change is necessary because we no longer require seniors to purchase insurance. Another change revises the language from “the Department shall enter into contracts with private insurers,” to “the Department may enter into contracts with private insurers.” The Department is suggesting this change because we want to be able to expand the available options for administering the program.
The Department also proposes to increase the maximum income for married couples from $21,500 to $28,660. Currently, the maximum income is $21,500 for both single individuals and married couples. The increased maximum income allowable for married couples will provide a fair distribution in the income levels. The Department increased the current maximum income of $21,500 by one-third to reach the $28,660 maximum for couples. A one-third increase is a common method used by other programs to determine an income level for couples. For example, pharmaceutical programs for seniors offered by some drug companies use a one-third increase for couples. There is approximately a one-third increase in the federal poverty level between one person and two persons to establish poverty guidelines.
[Ms. Smedes, continued] Since the Senior Rx program began, 190 couples with incomes between $21,500 and $28,660 have applied to Senior Rx. These couples were denied for not meeting the income eligibility requirement.
Additionally, we propose to adjust the maximum income levels for both single individuals and married couples annually in accordance with the Consumer Price Index (CPI). Many programs where the eligibility is based on income do include an annual cost of living increase tied to the CPI. For example, Nevada’s Property Tax Assistance Program for seniors allows for a cost of living adjustment in accordance with the CPI. Using the December 2002 CPI of 2.4 percent, the maximum income for Senior Rx would increase from $21,500 to $22,016 for individuals.
Increasing the maximum income each year will allow seniors currently enrolled in Senior Rx to remain on the program if their income increases slightly. A small increase in Social Security or other pension benefit could put some seniors currently enrolled over the maximum income and they would become ineligible for Senior Rx. There are currently approximately 75 seniors in the program who could become ineligible with just a 2 percent increase in their annual income.
The Department also proposes revisions to the income eligibility waiver section. As currently written, it is specific to new applicants to the program. There are no provisions to waive the income requirement for seniors already enrolled in the program who experience a temporary increase or hardship. For example, a one-time payment to a senior for an insurance distribution may put his income over the maximum. The senior may have used the distribution to pay medical bills or household expenses. Other seniors may have to sell their homes or cash out life savings to pay for medical bills or day-to-day living expenses. The Department believes there should be a method for these seniors to request a waiver of the income requirement.
Assemblyman Horne:
Two questions: First, in Section 1, the first paragraph, you said you changed to the permissive “may” enter into a contract with private insurers, because that expands your options. If [currently] we “shall” [contract with] private [insurers] and now you’re being given the option of “may,” where else would you expand to?
Jane Smedes:
We would like to have some available options [but we have] nothing specific in mind. We feel [the language is] limiting the way it’s written at this time.
Assemblyman Horne:
I figure there’s private and public.
Mike Willden, Director, Department of Human Resources:
[Introduced himself.] The “may” language actually gives us about three options we don’t have now. Right now the only thing in the statute is that we have to have an insured product. I think we’ve talked about this before. We have to go out through an insurance carrier and have an insurance policy issued to seniors in the Rx program. Another way to run it is for the state to run [the program] and so “may” would allow the state to run the Senior Rx program without an insured product. The third option would be that we could hire a pharmacy benefit management company and contract with the PBM (Pharmacy Benefit Manager). [They would] operate the program and we would reimburse them on a per-member, per-month basis. So those are three general options we would have.
Assemblyman Horne:
My second question [concerns] page 2, paragraph 5, lines 25 through 29, [where] it talks about the Department being able to waive eligibility requirements on household income. Is that only going to be available to the household income, not to the single?
Jane Smedes:
The definition of “household” for the program is either a single or a couple, depending on the circumstances.
Assemblyman Horne:
I just wanted to be sure because we struck “household” from the senior definition and I wanted to be sure they were covered, as well.
Assemblywoman McClain:
Of the three options, what do you consider “state operated?” Would that be the waiver that’s going to come out of A.B. 504?
Mike Willden:
That would be a portion of it. Seniors would be eligible with incomes up to $28,000. The waiver will only cover seniors up to $18,000, so through the Medicaid Program we would directly operate the waiver for the Medicaid-eligible population, those [with incomes] under $18,000. [For those with incomes in excess of] $18,000 [up] to the upper income limit, the state could either directly manage that or hire a PBM.
Assemblywoman McClain:
Have you done any analysis on it? Would [hiring a PBM or you operating the program] be cheaper than the insurance-based product we have now?
Mike Willden:
We’re continuing to do that analysis, as I have testified before. We certainly believe it would be less expensive than the contracted insurance model. We wouldn’t be paying the 3-3.5 percent insurance premium tax. [If we decided not] to reinsure the risk, that would be a savings also. Obviously, we won’t be making a profit and the current insurer has profit built into their cost.
Assemblyman Mabey:
What would happen if you had a senior citizen who was worth $1 million, but his income was below this amount? Would he still qualify for the Senior Rx program?
Jane Smedes:
Technically, yes, he would if his actual annual income was less than the maximum. However, if they have that many resources, they might have interest [income] that would put them over [the limit]. I think it would be doubtful that that situation would occur. It could, however, because we do not look at assets; it’s strictly based on income.
Assemblyman Mabey:
I would think that there are some senior citizens who just own real estate, which appreciates every year, so their income could be very low. Would they qualify for this?
Jane Smedes:
Yes, they would. When we verify income we look at their adjusted gross income on their income tax returns and we add their Social Security to that, because Social Security isn’t taxable. That’s what we look at to determine income.
Assemblywoman McClain:
If they have other insurance they could still qualify for Senior Rx, isn’t that true?
Jane Smedes:
Yes, that’s true. If they have other insurance they can still qualify.
Mike Willden:
Except [for] Medicaid.
Assemblywoman McClain:
Right. I’m wondering how this is going to work down the road. You’re going to take tobacco [settlement] money that’s currently paying the premium and use that to leverage for a Medicaid waiver. However, the Medicaid waiver is only going to cover people up to $18,000, which is about 85 percent [of the people now on the Senior Rx program], right? I’m worried that you’re going to end up bumping some people off of Senior Rx, especially now since you’re raising the income threshold, which will capture a lot more people. How are you going to adjust the amount of money you need for one [group and still allow the other groups to be on the program]? How are you going to keep track of all that?
Mike Willden:
The best way for me to deal with it is to think of building blocks from no income to $28,500. When we’re done moving forward into the next year, there will be three funding sources available for Senior Rx where there’s now only one funding source.
In this year and in prior years, only tobacco settlement dollars funded the Senior Rx program. By applying for the waiver, that lets us take the lowest income, those people below 200 percent of poverty, and use tobacco settlement [dollars] and/or General Fund dollars to match Medicaid waiver dollars for those eligible clients. Their costs will be paid for with roughly 50 percent [coming from] the federal government and 50 percent coming from either tobacco settlement dollars or General Fund dollars.
Assemblywoman McClain:
That’s assuming, and I’m sure you can verify this, that [it’s much cheaper] to provide prescription drug coverage for the state to [administer the program] than through an insurance-based product, is that correct?
Mike Willden:
That’s a true statement.
Assemblywoman McClain:
A lot cheaper? So you can get a lot more people on [the Senior Rx program]?
Mike Willden:
I don’t yet know [if it will be] a lot cheaper. There’s a cost-neutral requirement in getting a waiver. It’s just a lot cheaper than the current insurance policy. [Mr. Willden, continued] Remember, we’re dealing with Medicaid rules now. We have to prove to the feds that by spending some money [on an Rx program for] an eligible population, those seniors not in institutions, that we are going to defer future Medicaid enrollment and eligibility and/or be able to lower our institutional costs [by] bringing people out of institutions or deferring entrance into long-term care facilities. The neutrality is not measured by how much it cost in the Senior Rx program now [versus] how much less it’ll cost [with different management]. It’s basically shifting Medicaid dollars from one matching pot to another matching pot.
Assemblywoman McClain:
That’s my concern. When we start these shifts, if you’re not really saving money on one end, you’re liable to lose people who have been used to this coverage [but who] may not qualify any more because now you have to use all the money for people [eligible at] up to 200 percent of the federal poverty level.
Mike Willden:
Let me explain how we’re going to get there. We have [many] budgets closed [now] and I think the rest of the closings through the money Committees will happen in the next two days. As we indicated, we are going to increase enrollment [in the Senior Rx program] from 7,500 seniors to over 12,000 seniors. To do that we need two things to happen: We need to get a waiver and we need to get additional General Funds in the Budget, which we have. With those things in place, that allows us to take people off the waiting list and to go beyond and enroll up to 12,200 seniors. Depending on the efficiency of the waiver, how much money we save through that process, there may be additional money left in the Senior Rx account, some of those General Funds [might be] left over. There’s been some commitment to fund another Rx population, mainly the disabled population.
Assemblywoman McClain:
So the $7 million in tobacco [settlement] money and the $5 million in General Fund money will fund everybody who qualifies between $21,000 and $28,000 household income and a Medicaid waiver for everybody under $18,000?
Mike Willden:
The $5 million that was put in the Governor’s Budget was reduced to about $2.5 million by the money Committees. That action was taken because, instead of budgeting at the [approximately] $82.00 [per member/per month] that the budget was built on, it was lowered to [approximately] $66.00 [per member/per month]. So they took about half the General Fund [dollars] out of the Budget to make that adjustment. So there’s $7 million tobacco dollars and roughly $1-$1.5 million each year of General Fund dollars. That’s how we get to a 12,000-person enrollment.
To answer your question concerning whether we will be able to serve everybody that applies, I won’t know until we see how many applications come in. There still may be another waiting list by the end of the biennium.
Assemblywoman McClain:
That’s my concern. You’re raising expectations here that couples [with incomes] up to $28,600 qualify. I just don’t want any seniors not having prescription drug coverage that they currently have, no matter how it’s funded, and I don’t want to raise expectations to seniors that are going to end up on a waiting list again.
Mike Willden:
We’re not going to cause any senior that’s now funded to go off the program. That statement can be made clearly. In fact there are provisions in here that would ensure they don’t, since there’s the cost of living creep. If we don’t do something, there are about 75-100 seniors every year that are going to leave the Senior Rx program because they get a 2-3 percent Social Security increase that pushes them over the $21,500. They’re not going to be eligible for Senior Rx. This bill would allow that “bracket creep” to move up with their cost of living increases.
Will we always forestall the expectation, the waiting list? Probably for the next year or year and a half we’ll be able to take everybody that comes in the door. And we’ll be back in two years from now again, saying, “We’ve got 12,000 seniors enrolled,” but who knows where the end is—14,000; 15,000; 20,000? I don’t know.
Chairwoman Koivisto:
Further questions from the Committee? [There was no response.] We’ll close the hearing on S.B. 459 and bring it back to Committee. We’ll go to our work session. Let’s start with S.B. 82 and I’ll turn it over to Marla.
Marla McDade Williams, Committee Policy Analyst:
[Introduced herself.] I have a work session document (Exhibit C) prepared for you dated May 12, 2003. We have two bills on it. The first one is S.B. 82.
Senate Bill 82 (1st Reprint): Makes various changes concerning public health laws. (BDR 40-677)
We heard this bill on May 7. There wasn’t any testimony provided in opposition to the bill; however, a representative of the ACLU (American Civil Liberties Union) proposed one set of amendments. The attached items discuss those amendments. Additionally, a representative of the Nevada Eagle Forum expressed concerns regarding the court-ordered involuntary treatment and a person’s ability to know his rights if he has been involuntarily detained. Should the Committee wish to include a specific bill of rights for a person who is involuntarily detained, members may wish to consider adopting the following concept:
Require the health authority to adopt regulations setting forth the rights of a person who is involuntarily isolated or quarantined. Such regulations must include a requirement to provide a person with a list of his rights, and they must specify the time by which a person must be given the list.
I haven’t had an opportunity to discuss this option with any representatives of health authorities. If the Committee’s not comfortable with this we might bring Dr. Todd forward to discuss it.
If you turn to the next page, there’s a discussion document that I put together that corresponds with the amendments that were recommended by the ACLU. I’ve actually narrowed it down to five amendments that the ACLU has requested. I’ll go through those points now.
The ACLU recommended deleting language from the bill as it relates to past actions of a person and the court proceedings. There is suggested language for deleting the sentence or sentences related to that. Section 21 would then read,
“In proceedings for involuntary court-ordered isolation or quarantine, the court shall hear and consider all relevant testimony, including, but not limited to, the testimony of examining personnel who participated in the evaluation of the person alleged to have been infected with or exposed to a communicable disease and the certificates, if any, of a health authority or a physician, licensed physician assistant or registered nurse accompanying the petition.”
In point two, after testifying and reviewing, that point was withdrawn. It had to do with the notation of least restrictive environment that is in Section 29. However, when it’s codified, that will be in the first part of Chapter 441A.
In point three, the ACLU recommends adding a specific right to refuse treatment. This concept was presented in the Senate Committee on Human Resources and Facilities and subsequently adopted by that body. Currently, the premise concerning the right to refuse treatment is carried throughout the bill by using the terms, “consensual medical treatment.” I identified the sections and the lines where those terms occur. If a court orders involuntary treatment, the court must consider the rights of the person and the desires of the person concerning treatment. While acknowledging that the terms “consensual medical treatment” may have been written into the bill to accommodate his amendment, I spoke with Dr. Siegel this morning, and he notes that one’s ability to consent to treatment is different than being told that he has a specific ability or right to refuse treatment. Again, should the Committee wish to discuss this issue and whether it’s appropriate to establish a specific right to refuse treatment, members may wish to hear from a representative of the public health community.
[Ms. McDade Williams, continued] In point four, the ACLU recommended changing the number of days for which a court-ordered isolation may be renewed to 14 days or less. As noted in testimony, there are circumstances for which an extended period of time may be required for an isolation or quarantine. Further, when such actions are taken the public health community is cognizant of the impact of such decisions on the individual as well as on society. Again, after talking with Dr. Siegel about this, he acknowledges that he’s not adamant that the reference period be 14 days or less. However, he’s certain that he would like the reference to 30 days and 120 days removed from the bill. I also spoke with Dr. Todd about this and he suggested that the designated periods are adequate. I did propose some compromise language, if the Committee wants to consider that, which would say that at the end of the court-ordered period of isolation or quarantine the health authority may petition to renew the detention of the person for additional periods not to exceed the expected duration of infectiousness or 120 days, whichever is shorter, for each renewal. I didn’t change the recommendation concerning 30 days. I think it says the order expires after 30 days or unless terminated by a health authority, that’s the existing language in the bill.
In point five, the ACLU recommends including a religious exemption from treatment, including immunization, particularly as it relates to involuntary, court-ordered isolation and quarantine. Subsection 1(b) of Section 24 includes language specifying that the court may order the most appropriate course of treatment for a person after considering his rights, including the specific rights of a person who depends on prayer for healing. This statute itself is relatively narrow. Further, as noted previously, a person’s ability to refuse treatment may be considered by a court, but he does not have a specific right to refuse treatment. Although the following suggestion does not grant a person a religious exemption from treatment, should the Committee wish to refer to one’s religious preferences, Section 24 may be amended by inserting “the rights of a person to follow the tenets of his religion” after NRS (Nevada Revised Statutes) 441A.210.
[Ms. McDade Williams, continued] This language would allow the court to consider a person’s religious rights, but it does not extend the right of a person to claim a religious exemption from treatment. Further, in terms of the immunization issue, I spoke with Dr. Siegel. He specifically wants to grant a right to refuse immunization. The term itself isn’t referenced in the bill. In considering this issue, the Committee may wish to clarify that “treatment,” as it is referred to in the bill, does not include general prevention of disease. Further, immunization or vaccination may be the recommended treatment for certain diseases. For example, Dr. Todd notes that the recommended treatment for smallpox, if a person has been exposed to the disease for less than three days, is vaccination. While a person has the right to consent to this mode of treatment, as noted in preceding text, Dr. Siegel advocates that he also have a specific right to refuse an immunization as part of his treatment for smallpox. The Committee will have to decide on the public policy [issue] and whether they want to extend a specific right to refuse immunization as part of one’s course of treatment, or whether allowing one to consent to being immunized as his course of treatment is sufficient.
Point six was withdrawn. That related to immediate injunctive relief and was already accommodated in the bill. I’ve identified those sections and did talk to Dr. Siegel about that and he’s okay with that.
[Dr. Siegel] withdrew point seven in his testimony which related to who can order a quarantine.
On point eight, the ACLU advocates a good-faith effort by telephone and in writing to the spouse or legal guardian of a person, notifying him or her that the individual has been detained. There is language in Section 13 that requires a medical facility to “reasonably attempt to ascertain the identification and location of the spouse or legal guardian.” I did talk to Dr. Siegel about this. He doesn’t feel that mail notice is adequate. I’ve suggested some language that says,
“specify that if a person is unconscious or otherwise unable to communicate because of mental or physical incapacity, a medical facility, the health authority, or the court should be required to notify the person’s spouse or legal guardian via the telephone in addition to using the mail. The entity that is required to make the notification depends on whom the person who is unable to communicate first comes into contact. Further, if no contact is made with a person’s spouse or legal guardian by the first entity, the subsequent entities should be required to make the notifications.”
Assemblyman Hardy:
On point five where a person has a treatment mandated for smallpox and refuses the treatment but has been exposed it: Would that person then have a difference in quarantining than they would otherwise? I’m probably asking for professional input on that. Would there be an instance where we have to immunize somebody in order to protect the public health, or is there a position where we can quarantine that person or isolate that person to prevent the further spread?
Randall Todd, Ph.D., State Epidemiologist, Health Division, Department of Human Resources:
I believe under the circumstances you describe, if an individual were to consent to be vaccinated and it were possible to vaccinate them within that window period, then that could shorten the duration of any quarantine that would be required of them. I would hesitate to say that it would do away with it entirely because we know that vaccination is not 100 percent effective after exposure, but is thought to be fairly effective up to about 3 days after one has been exposed.
Assemblyman Hardy:
If you didn’t consent to vaccination, your quarantine would be longer than otherwise in most likelihood but still within a 14 – 21 – day time frame?
Randall Todd:
Yes, Dr. Hardy. In order to protect the public’s health and also recognize the right of an individual to forego treatment or vaccination if that is their choice, we would have to impose a quarantine period for the maximum duration of the incubation period for the disease in question.
Assemblyman Mabey:
I’d like to follow up on what Dr. Hardy said. How do you feel? If somebody has a religious reason for not being treated or just doesn’t want to be treated, what would they have to do as the bill is written now?
Randall Todd:
My read of the existing language is that an individual would have a right to refuse treatment under religious objection because the court is required to consider NRS 441A.210. I’m not an attorney but my read of [NRS 441A.210] sounds fairly cut and dried. It says that a person who has a communicable disease and depends exclusively on prayer for healing in accordance with the tenets and precepts of any recognized religious sect, denomination, or organization, is not required to submit to any medical treatment required by the provisions of the chapter, but may be isolated or quarantined in his home or other place of his choice acceptable to the health authority, and shall comply with all applicable rules, regulations, and orders issued by the health authority.
[Dr. Todd, continued] While I understand the ACLU’s point – they would like it to be rather specific and perhaps to go beyond merely the reference to [NRS] 441A – it causes me to wonder why, as long as we’re telling the courts in that section that they have to consider the person’s right to this, the person’s desires for that, or the person’s wishes for another thing, I don’t see language in here that says that the courts should also consider the right of the general public to be protected from potential sources of infection. I wonder if we do want to impress upon the courts, “You really must consider the wishes of the individual.” Maybe that ought to be counterbalanced in some way with reminding the courts that they must also consider the rights of the rest of us to be protected from sources of infection.
Chairwoman Koivisto:
Janine, I know you had some concerns about this very section. Do you want to tell us what your concerns were and maybe you might have some suggestions?
Janine Hansen, President, Nevada Eagle Forum:
I am very concerned about this section because the definition in [NRS] 441A.210 is very narrow. It defines [a religious exemption] only for people who depend exclusively on prayer for healing. They’re the only ones whose religious rights would be recognized at all. There are other statutes, for instance those on immunization with regard to school, that are much broader than that and allow people to have … like it identifies the Nevada State Constitution right of conscience with regard to those issues. In fact, the Nevada State Constitution, in our ordinance which adopted us as a state, says that the state has to have a perfect toleration of religious sentiment. That was adopted in Article 17 of the Nevada Constitution as a part of the state law.
I do support this bill. It’s so much better than it began. But I am concerned about the fact that this definition for religious protection is so narrow as to exclude almost everyone except one specific group of people.
In the recommendations from Committee staff, from Marla who met with me this morning, [I like] this suggestion in the middle of page 3 that says, “the rights of a person to follow the tenets of his religion,” and that the judge should take that into consideration. Of course, this person isn’t going to be able to be out on the street. If they refuse treatment because of religion they have to be quarantined. That’s obvious. They can’t be running around infecting other people because they choose to have a religious exemption. They will be subject to isolation and quarantine so the public is protected in that way, as I see it.
[Ms. Hansen, continued] I think there ought to be a recognition of religious rights beyond one specific religion. It discriminates against all other beliefs. If our public health authority wants to protect us, which is important, they do have to maintain those people in isolation or quarantine, so they are protected in that way. And the judge can still, under what’s recommended here, force them to have treatment, although I object to that. I think they ought to have to be forced to be quarantined, certainly. I think the bill does not adequately address the religious issue.
Assemblyman Hardy:
On our point five discussion, amend Section 24 by inserting, “the rights of a person to follow the tenets of his religion,” does that address your concern?
Janine Hansen:
I think that’s much better than we have now. I am a little concerned that it would have to be the tenets of a particular established religion.
Assemblyman Hardy:
It just says, “the tenets of his religion.”
Janine Hansen:
I’m hoping that doesn’t mean it has to be particular established religions [such that the religions] have a particular organization. A lot of people have conscientious beliefs and religious beliefs that may not be a part of an organized religion. That is of concern to me. It’s almost as narrow as the other [definition] in that they have to have a religion defined by healing by prayer. I’m not sure that’s what that means. Maybe Marla can tell us specifically what it means. If it means it has to be a specific, identified, organized religion, I think that excludes a lot of people who may have non-traditional religions, whatever you want to call them.
Assemblyman Hardy:
We can include that [as our Legislative intent] but if we said, “the rights of a person to follow the tenets of his individual religion,” would that work?
Janine Hansen:
[We could add],“…or religious preferences.” Yes, I think that’s better, “…individual religious preferences.”
Assemblyman Hardy:
“…of his individual religious preferences.”
Chairwoman Koivisto:
I think if, after “his religion,” we added “or beliefs,” that would broaden it without going too far.
Janine Hansen:
I agree, Madam Chairwoman. I think that’s an excellent suggestion and that would cover my concerns for people who aren’t in an organized religion.
Chairwoman Koivisto:
Right, because that certainly deals with personal beliefs.
Janine Hansen:
Yes, which is essentially the right of conscience.
Chairwoman Koivisto:
Any other questions from the Committee; concerns from the Committee?
Assemblywoman Pierce:
I’m still concerned. This still makes me nervous, especially the part about “or a group of persons.”
Let me say that the places that have been successful in the last 20 years controlling outbreaks of disease have been places that used education. This is not how you take care of disease. You take care of disease through education and then people do come forward and do what needs to be done. That’s why I’m nervous about what seems to me to be sweeping controls on people.
Janine Hansen:
I certainly appreciate Ms. Pierce’s concerns. One of the things that I found so much better in this particular legislation than in the current law is that the current law on the books does not provide any of these safeguards with regards to appeal or due process. They don’t provide any of those rights in the current law. This is a great improvement and it makes me feel a lot better than the current law because we have those [safeguards].
I’m still very nervous. I talked about how does a group of persons have rights. I have concerns about that. I think one of the ways to help protect [those rights] that Marla has suggested is that, when someone is quarantined or they’re taken in for treatment or whatever, they have to be given something. My suggestion is that they actually be given something that shows them what their rights are. That these [rights] be specifically identified in writing and given to the person, in addition to [the person] being able to make a phone call. They have the right to refuse treatment and they have the right to be in the least restrictive environment. If a person had to be given a list of their rights when they were taken into custody, I think that their rights would be much more likely to be protected. Most people would have no idea what their rights were; they would have never experienced this before. If they had to be given a list of their rights, just a piece of paper with their rights [listed] on it, probably they’d be much more likely not to violate your rights because they know the people [in custody] would know what [their rights] were. Secondly, the people [in custody] would be more likely to assert [their rights such as], “I have the right to refuse treatment,” or, “I have the right under my religion to refuse treatment.”
[Ms. Hansen, continued] If people know [their rights], I think those rights are much more likely to be protected than they are now. My suggestion is that they actually be given something [with those rights] listed for the protection of both [the people] imposing the law on them and for themselves.
Assemblywoman Pierce:
I am more comfortable with the amendments. I think they are better. I like the actual writing down of the rights and giving [of that list] to people. That does make me feel better.
For me the sticking point is the language, “or groups of persons.” It’s so broad and vague and I just worry about it. We’ve rounded up people right now who we are holding in this country who do not get to see a lawyer and have not seen a lawyer and no one knows their names and nobody knows anything about them other than that we’re holding them. I’m still worried even though [Assemblyman] Williams says I should not be.
I feel better about the rest of [S.B. 82] and I do appreciate the discussion about the religious part. I think it’s important to remember that half of all Americans don’t go to church. They have a right to their belief system and to living according to that belief system. I appreciate the Chairwoman’s adding that “belief” part [to the language]. I think that’s important.
Chairwoman Koivisto:
I think it’s good to remember that under current law all these things can be done. To do groups of persons would have to be done one person at a time. This is not something that would be invoked except in an emergency situation. The current SARS (severe acute respiratory syndrome) thing certainly hasn’t triggered any great public health violation of rights when, under our current law, we certainly could see some violations of due process and individual rights.
Having seen the 80 pages we started with and what has been revised and redone and come down to this, [S.B. 82], I’m confident that this is good legislation.
Randall Todd:
Madam Chair, could I take you back to point four for just a moment? [Chairwoman Koivisto agreed.] The suggested language there talks about isolation or quarantine not exceeding the expected duration of infectiousness or 120 days, whichever is shorter, for each renewal. That needs just a little bit of clarification. Not exceeding the duration of infectiousness would be an appropriate restriction to put in there for isolation, but might, in fact, be too long for quarantine. I would suggest that you might want to have that read, “not to exceed the expected duration of infectiousness for isolation, and not to exceed the maximum period of incubation for quarantine, or 120 days, whichever is shorter.” Some diseases could remain infectious for a very long time but their incubation periods might be relatively short.
Chairwoman Koivisto:
Comments or questions from the Committee? [There were none.] I think Marla has all the suggested amendments. Are you comfortable with what we’ve [been discussing]?
Marla McDade Williams:
Maybe we could go through them point by point.
The Committee’s okay with what is on the first page about the list of rights and point one with taking out that language about past history.
On point three, did we want to make any specific reference that a person has a right to refuse treatment or does “consensual medical treatment” suffice?
Assemblyman Horne:
After reading that, I agree. I know it sounds like legal gobbly-gook, but it’s true. A whole lot can turn on a phrase and to have just the phrase in there, “consensual medical treatment,” may only address one part of the equation. I think it’s important to also put in that they do have the right to refuse.
Marla McDade Williams:
Okay, going forward then on point three we do add, “specific right to refuse treatment.”
On point four we discussed the language that Dr. Todd just revised, adding, “expected duration of infectiousness or isolation and not to exceed the maximum duration for incubation for quarantine.”
Randall Todd:
Probably to be technically correct it should say, “not to exceed the maximum period of incubation,” or “not to exceed the maximum incubation period.”
Marla McDade Williams:
[Someone asked, “Is that instead of specific days?”] That’s in addition to days. It would say, “not exceed the expected duration of infectiousness for isolation or not to exceed the maximum period of incubation for quarantine, or 120 days, whichever is shorter, for each renewal.”
Moving on to point five, we’ve agreed to language there to amend Section 24 by inserting, “the rights of a person to follow the tenets of his individual religion or beliefs.”
On immunization, did we come to consensus about whether or not we would grant a specific right to refuse immunization?
Chairwoman Koivisto:
I think that should also fit with the “tenets of his religion or beliefs.”
Marla McDade Williams:
Okay, I’m clear [on that].
Janine Hansen:
Madam Chairwoman, you’re not going to specifically identify it, you’re just going to allow it to fall under “beliefs?” And it’s identified there?
Chairwoman Koivisto:
Right. Have it follow the same as in Section 24 where it’s the rights of a person to follow the “tenets of his religion or beliefs,” then use that same language for the vaccination portion.
Janine Hansen:
So, are you adding the vaccination there or just assuming it falls under the “beliefs?”
Chairwoman Koivisto:
It would be adding.
Marla McDade Williams:
Back to point eight and the language there at the bottom of the page specifying that, if a person’s unconscious or can’t communicate, the facility may contact the person’s spouse or legal guardian by telephone in addition to mail.
ASSEMBLYWOMAN ANGLE MOVED TO AMEND AND DO PASS S.B. 82.
ASSEMBLYMAN HARDY SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY.
Mrs. Angle, do you want to do this on the Floor? [Mrs. Angle concurred with that request.]
Senate Bill 327: Provides for reuse of certain prescription drugs. (BDR 39-66)
Marla McDade Williams:
The next item is Senate Bill 327. We heard this bill on April 23. This is Senator Wiener’s bill to provide for reuse of certain prescription drugs. The bill was scheduled for consideration on April 30. No action was taken at that time. Since then, one specific recommendation has come forward, that would delete language in the bill that allows drugs to be transferred to a non-profit pharmacy, and I’ve identified the sections where that language occurs.
Chairwoman Koivisto:
Comments or questions from the Committee?
ASSEMBLYWOMAN McCLAIN MOVED TO AMEND AND DO PASS S.B. 327 BY DELETING THE REFERENCE TO NON-PROFIT ORGANIZATIONS.
ASSEMBLYMAN HORNE SECONDED THE MOTION.
Assemblywoman Angle:
The reason I did not second the motion was because I liked that provision to include the non-profits. I think that would be something we would want to allow since we in the north have HAWC (Health Access Washoe County), which might be able to take advantage of these medications. That was my hesitation.
Chairwoman Koivisto:
The concern of many of the Committee members was the tracking that would be involved if the pharmaceuticals were not in a controlled environment, the way they would be for the rest of the bill. Until we have a track record so that we know how well it works in a controlled environment, there’s real concern about allowing it in another venue. Does that help your concern?
Assemblywoman Angle:
It helps me understand where the Committee is coming from. Having known of non-profits like HAWC [they have] controls and they have physicians who administer those kinds of things. That was my only concern.
Chairwoman Koivisto:
Any other discussion? [There was no response.] Okay, I’ll place the question.
THE MOTION CARRIED. (Assemblywoman Weber and Assemblyman Hardy voted no. Assemblywoman Leslie and Assemblyman Williams were absent for the vote.)
Do we have anything else to come before the Committee? [No one replied.] Seeing nothing, we’re adjourned [at 2:42 p.m.].
Terry Horgan
Committee Secretary
APPROVED BY:
Assemblywoman Ellen Koivisto, Chairwoman
DATE: