MINUTES OF THE ASSEMBLY COMMITTEE ON HEALTH AND HUMAN SERVICES Sixty-eighth Session June 26, 1995 The Committee on Health and Human Services was called to order at 2:30 p.m., on Monday, June 26, 1995, Chairman Jan Monaghan presiding in Room 330 of the Legislative Building, Carson City, Nevada. Exhibit A is the Agenda. Exhibit B is the Attendance Roster. COMMITTEE MEMBERS PRESENT: Mrs. Vivian L. Freeman, Chairman Mrs. Jan Monaghan, Chairman Mrs. Jan Evans, Vice Chairman Dr. William Z. (Bill) Harrington, Vice Chairman Mrs. Deanna Braunlin Ms. Barbara E. Buckley Mr. David Goldwater Ms. Saundra (Sandi) Krenzer Mr. Dennis Nolan Ms. Dianne Steel Ms. Patricia A. Tripple Mr. Wendell P. Williams GUEST LEGISLATORS PRESENT: Senator Maurice E. Washington STAFF MEMBERS PRESENT: H. Pepper Sturm, Chief Principal Research Analyst OTHERS PRESENT: Tony Gladney, MGM Grand Hotel Annie Rees, Annie's Bail Bonds Brenda Goodwin Rebecca Davis May Shelton, Washoe County Social Service Denell Hahn, Clark County Social Service Jan Gilbert, League of Women Voters Jon Sasser, Nevada Legal Services Ed Davis, National Association of Social Workers Rick Reich, Clark County Coalition of HIV/AIDS Providers Carlos Concha, Division of Parole and Probation ASSEMBLY BILL 605 - Provides that certain persons arrested must be tested for sexually transmitted disease. Rick Reich, AIDS Services Coordinator for Clark County and secretary of the Clark County Coalition of HIV/AIDS (Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome) Providers, expressed that group's concerns with A.B. 605 which included funding and the potential for abuse. Mr. Reich stated A.B. 605 would allow the release of information to a victim or first responder. He noted under the same set of circumstances, for instance an exposure in a facility, neither the facility nor the person exposed would be allowed to have that information. He noted all agencies have had to develop mechanisms under their bloodbourne pathogen guidelines to deal with exposures. Mr. Reich testified amending that portion of NRS (Nevada Revised Statutes) would remove the original intent which was to work with victims who had been sexually exposed but who had no ability to control the situation or utilize any advanced safeguards. He emphasized the need to protect confidentiality and advised some type of mandatory postexposure follow-up. For instance, if one wanted to use the bill to test someone's blood and know the results, that person would have to enroll in a postexposure plan. Assemblywoman Buckley inquired how notification under existing statutes works. Mr. Reich explained he is currently involved with two types of notification under NRS 441A. The first is victim notification where he receives a blood sample drawn by the correctional facility or law enforcement agency and submitted for analysis. It is taken to their lab where an analysis for syphilis is done, then it is sent on to a private lab for HIV testing. The lab notifies his agency of the results. His agency was also provided information completed by the law enforcement agency stating the name, age, sex, race and address of the perpetrator as well as the same details about the victim. If the victim is a minor information is provided about the parent or guardian. After getting the analysis, a certified, return receipt letter offering support counseling or follow-up testing is sent. Mr. Reich explained the second, more common type of health department follow-up he is involved in is partner notification of people exposed to communicable diseases. People are told they have been exposed to an infection and that they should seek out testing or treatment for whatever disease is being followed-up. At no time is the source person identified, Mr. Reich stressed, and that helps maintain their credibility in the community. Carlos Concha, Acting Deputy Administrator of Parole and Probation, maintained his department had offered amendments to A.B. 605 which were intended to clear up the coalition's concerns about the bill. Regarding the costs of testing, Mr. Concha mentioned under OSHA regulations the employer bears those costs. In regards to the potential for abuse, Mr. Concha stated the amendment that makes the Health Authority responsible for investigating the alleged transfer of body fluids would prevent someone from simply alleging an exposure had occurred to force the testing of a particular individual. Regarding the coalition's idea to have the person requesting information fall under NRS 201.205, Mr. Concha emphasized that person would be committing a felony if engaging in unprotected sex with anyone, even a spouse. Chairman Monaghan indicated A.B. 605 would go to the Assembly Committee on Ways and Means if it passed out of this committee. She also mentioned NRS 201.205 was not covered under A.B. 605. Assemblywoman Evans agreed with Mr. Reich's concerns regarding confidentiality and abuse however she also expressed sympathy for Mr. Concha's concerns about the safety of police officers, firemen and other first responders. She inquired what Mr. Reich could submit to clean up the bill and make it acceptable. Mr. Reich testified the coalition wanted the original language that would require testing only for sexually transmitted diseases and not the version amended by the committee that would require testing for commonly contracted communicable diseases. He stated the burden to test for all those diseases was unbelievable. Mr. Reich also reminded committee members once a person is exposed to HIV nothing can be done. He suggested on lines 18 and 19 the words "at the request of the victim" be removed so the line would read, "the victim, witness, peace officer . . . will be provided an examination for HIV." Mr. Reich emphasized the need for specimens to be submitted to the state laboratory rather than burdening the Clark County Health District. He also maintained the amendments belonged in the portion of the statutes relating to release of information where confidentiality is breached. Mr. Reich stated there is already a clause allowing for the release of information to firemen, policemen and paramedics. Mrs. Evans indicated the committee was at an impasse because they understood and appreciated both points of view. She noted there was not much time left in the legislative session to work the problem out, and emphasized the two parties should sit down and, if anything can be agreed upon, present it to the committee. Assemblyman Goldwater mentioned S.B. 435, which passed the Assembly Judiciary Committee the preceding day, does essentially the same thing as A.B. 605. He stated his belief the issue had been handled by another committee. Mr. Concha agreed. Ms. Buckley stated if a police officer felt he had been infected by someone who was arrested or there had been an exposure, under OSHA regulations the police department must pay for testing and inquired if that was correct. Mr. Reich agreed they have to pay for testing if the source can collect it. He added all the follow-up in OSHA (Occupational Safety and Health Administration) and the bloodbourne pathogen policies that had been developed cover everything except for the testing of an individual and the release of information about the result. There is the power for the health authority to release the result on an individual on a medical need-to- know basis but it did not allow for the health department to collect that specimen. Assemblywoman Krenzer emphasized police and firemen are completely covered by workers' comp which pays for all those services. Mr. Reich explained he had been referring to the costs of testing the source person. Ms. Krenzer maintained some self-insured employers as well as police and firefighters require the entire bloodbourne pathogen program be seen through once an incident report is filed. Ms. Krenzer also indicated her belief that the fiscal note on A.B. 605 is low. Mrs. Monaghan closed the hearing on A.B. 605. SENATE BILL 428 - Requires establishment of program for self-sufficiency of applicants for and recipients of aid to families with dependent children. Senator Maurice E. Washington, representing Washoe County Senatorial District No. 2, presented an explanation of his bill with supporting documentation to committee members, (Exhibit C). Senator Washington explained S.B. 428 is a pilot program that would begin January 1, 1997 and target 3,000 people. He also indicated his bill simply reflected proposals contained in anticipated federal block grants. Assemblyman Williams agreed the issue of welfare must be addressed however he objected to the opening statements which referred to "illegitimate children, illegitimate families and households without fathers". Mr. Williams indicated he had been taught "all children are God's children and we should respect them, and their families, as legitimate." Mr. Williams, a product of public housing and a single parent household, objected to the terminology Senator Washington used in his opening statement. Referring to welfare abuse and fraud, Mr. Williams stated it was probably much less than in other government programs. He reiterated he would be interested in addressing the welfare problem, which he agreed needs to be addressed. Senator Washington emphasized the behavior of bringing a child into the world and then turning one's back is irresponsible because the burden of child rearing then falls upon only one parent. He also believes welfare has fostered and promoted the problem. The senator wants responsibility for rearing children placed upon the parents in hopes of decreasing the rate of illegitimacy. He emphasized children need to be raised by parents who have consented to live together and are prepared to assume that responsibility. Mr. Williams asked how children could be considered illegitimate because of someone else's actions. Senator Washington replied he is not speaking about the children but about the behavior patterns of a woman and a man and agreed the children should not be penalized. Ms. Buckley disclosed she was a tenured employee with Nevada Legal Services and had represented welfare recipients. She is not currently employed by Nevada Legal Services, has no conflicts and would be voting on S.B. 428. Ms. Buckley, referring to Senator Washington's statement that he is concerned about people who become dependent upon welfare, noted the bill cuts people off welfare after 24 months, with one six month exception for emergencies. Senator Washington stated in Section 12, sub 3, lines 39 through 41, S.B. 428 provides exemptions for those people currently enrolled in school. He noted there is also an additional twelve month transitional period. Assemblywoman Tripple inquired if S.B. 428 addressed the problem of keeping youth in school so they would be able to get a head start and not end up on welfare. Senator Washington explained Section 23 requires attendance in school. When the parents go through their evaluation or three month assessment review, they would bring in a report card indicating their children are attending school and their academic progress is at standard. If there was a problem the social worker or case manager would be able to detect it and offer the necessary help. The senator emphasized the importance of education in his program. Ms. Tripple stated the schools had an obligation to assist with tutorial help and support because the success of the program depended upon more than simply attendance in school. Assemblyman Goldwater commented S.B. 428 is attempting to change people's behavior and the parts of the bill he supported were those that reward rather than penalize. He inquired why there were not more positive rewards. Senator Washington replied those who wanted to get off welfare were rewarded with as many incentives as possible. He noted there were more incentives and rewards for compliance, than there were sanctions for non-compliance. Mr. Goldwater expressed concern that S.B. 428 is telling poor people if they do not live the way the state of Nevada says they should live, the state will not help them. Senator Washington disagreed and stated S.B. 428 tells people there are penalties for noncompliance because that is the way the world is. To receive all the benefits of the bill, a person must do certain things. Assemblywoman Freeman inquired what S.B. 428 was doing for children in the school system and, mentioning Section 23, stated she saw nothing that would encourage people to improve conditions in their families as related to schools. She also asked how one would force a man who "spawns" a child to take responsibility for that child. Senator Washington stated S.B. 428 does address presumptive fathers by redefining "household" so the presumptive father can participate in the assessment. He stated if the young mother is willing to establish paternity, the young man can become part of the program in which case welfare benefits would be increased. If he is working and will not participate the state would go after revocation of his driver's license or other professional license. Senator Washington said S.B. 428 cannot address all the educational issues that need to be addressed, however it does try to encourage school attendance. Mrs. Freeman asked whether the senator had any proof welfare parents do not get their children to school. Senator Washington asserted he had a lot of proof and indicated they frequently either do not enroll their children or take their children out of school to watch other siblings. He also noted S.B. 428 provides for parenting classes and encourages maundering programs. Mrs. Freeman inquired if there were funding for parenting and maundering classes in the bill. Senator Washington replied there was funding for parenting classes in the revised fiscal note, (Exhibit D,) and that mentoring classes were volunteer programs. Mrs. Monaghan requested people in the audience who had traveled to Carson and were not employed by a governmental entity nor lobbyists to raise their hands. (Five individuals raised their hands.) She indicated a desire to hear their testimony before this hearing adjourned. Ms. Krenzer mentioned strike provisions during labor disputes contained within S.B. 428 and requested the language in the bill be amended and the term "labor dispute" be removed. She also mentioned the exemption in the bill for the handicapped and stated she disagreed with that exemption. Senator Washington agreed with her proposed amendment concerning "striking" workers. Senator Washington informed the committee if federal block grants were enacted, all states would be required to reduce their caseload by ten to fifteen percent and S.B. 428 would enable Nevada to do that. Tony Gladney, Community Affairs Manager at the MGM Grand Hotel, testified about a program at the MGM similar to S.B. 428 that has saved the taxpayers of Nevada $3.5 million and hired over 1,200 economically disadvantaged individuals. He explained the MGM Grand Hotel, prior to opening, entered into a partnership with Nevada Business Services utilizing job training partnership funds. The contract stressed hiring 1,200 economically disadvantaged and targeted individuals receiving unemployment, welfare recipients, dislocated workers, the mentally and physically challenged, displaced homemakers, seniors and youth. The qualifications for this employment program were a willingness to work and a positive attitude. The MGM utilized 70 agencies within Clark County such as vocational rehab, Catholic Community Services and state welfare and then empowered the agencies to do what they normally do. There were many workers who entered the program who were already job ready however many were not and needed instruction in such basics as hygiene, time management, proper attire and language skills. The success of the MGM's program indicated what private/public partnerships can accomplish. Mr. Gladney testified over 1,462 individuals entered their program of whom 823 were welfare recipients. The number still employed at the end of 1994 totaled 1,292 of which 641 were former welfare recipients. The program paid over $20 million in wages with former welfare recipients receiving over $9 million of that figure, not including tip earnings. Mr. Gladney also noted many managers tell him the people hired under this program are better than those hired through the regular application process. Brenda Goodwin spoke in favor of S.B. 428 stating she was a former welfare recipient currently employed by the state. She emphasized if it had not been for assistance programs that enabled her to go to business school, which were a requirement for receiving aid, she would never have escaped the welfare trap. She believed the majority of people on ADC (Aid to Dependent Children) would be willing to get off if given the opportunity because no one wants to rely on someone else. Annie Rees, owner of Annie's Bail Bonds, testified she views S.B. 428 from many perspectives. The current system of welfare has become a way of life and for some families she sees it is almost like a family business that is passed from generation to generation. She stated she is appalled when ADC checks are offered to her as payment for bail for recipients' family and friends. Ms. Rees noted bail bondsmen refuse to accept those checks because the moneys are meant for the children. She stated many times the charges are alcohol or drug related and Section 22 of the bill would require alcohol and drug abuse prevention and treatment for participants in the program. She emphasized those programs are vital for a healthy home and recounted occasions when she witnessed babies in local hospital nurseries suffering from the effects of drugs and alcohol their ADC moms took during pregnancy. Ms. Rees reiterated the only hope for Nevada's children is treatment for those moms and education for them and their children. Sections 23 and 25 of S.B. 428 provide for the education of children and their parents. Even more important, Ms. Rees believed was Section 26 which helps to teach parenting skills and personal responsibility. Ms. Rees emphasized her profession shows her repeat clients who are sentenced to a life cycle of crime and welfare. Because S.B. 428 provides for self-sufficiency within a prescribed period, Ms. Rees believes the life cycle of welfare can stop but recipients must be educated and develop a sense of personal responsibility if they are to break free of the cycle. Ms. Rees indicated she hit a rough spot in her life 16 years ago when she was a new divorcee with two children and no job skills. She combined public assistance with her father's advice to "pick herself up and take responsibility for her own life" and made a real success of herself. Rebecca Davis testified her son provides the best motivation to get herself off drugs and into a good job and she is voluntarily doing the things S.B. 428 would mandate such as attending school. She indicated her biggest difficulty going back to school was affording child care on ADC benefits but she emphasized Senator Washington's bill would provide that resource. Because she wants to get off the welfare system she can be helped through passage of S.B. 428 and that was important. Ms. Davis stressed not only the people targeted by the bill can get off welfare, but those who are not mandated can also use it to climb out of poverty. She added the only thing more hopeless than poverty was not having the will to do better. Ms. Davis related she got off drugs because the criminal justice system mandated it. ADC has allowed her to go back to school and learn skills other than running keno, where she was around drugs or being a cocktail waitress, where she was around alcohol, which were the only two skills she had. If S.B. 428 is passed, Ms. Davis will be able to learn skills to make her son proud of her. Ed Davis, a licensed social worker and member of the National Association of Social Workers, testified in opposition to S.B. 428 and stated the problem the bill attempts to address is not simple. Mr. Davis found fault with the bill in three areas. The first area is the many ways it is punitive such as "three strikes and you're out." Mr. Davis questioned what would happen to the families under those circumstances. Mr. Davis also objected to the "family cap" which he believed would lead to more abortions than abstinence. Referring to the provisions concerning school attendance and progress, Mr. Davis mentioned child welfare law has always taught if we are going to support families and parents we should not pass laws that would mean the children could blackmail the parents and in this case, it could easily happen. The second area in which Mr. Davis found S.B. 428 inadequate was that it is virtually unfunded. Both the Bureau of Alcohol and Drug Abuse and Employment Training and Rehabilitation testified to the Senate they would need over $9 million in additional money to provide services mandated in the bill, but the Senate refused both requests. The third area Mr. Davis objected to was lack of specified staffing criteria. Section 11 requires a comprehensive assessment and treatment plan for each individual who is applying. Those would basically be psychosocial assessments and those are administered by social workers and other people trained to work with psychosocial problems. However he noted S.B. 428 does not provide any requirements for social workers or case managers. In conclusion, Mr. Davis reiterated many programs were mandated by the bill but no services were provided. S.B. 428 puts the total onus and responsibility on the recipient for fulfilling the requirements of the case plans and if those are not fulfilled, the person would be dropped from the program in two months. Mrs. Evans agreed for S.B. 428 to work trained social workers and the ability to spend time with the clients on a continuing basis for assessment and re- assessment would be required. She asked what kind of case load would be necessary. Mr. Davis replied 40 to 50 clients per case load would be the maximum. Mrs. Monaghan reminded the audience S.B. 428 would be heard again on Wednesday. Ms. Krenzer asked what impact reduction of the number of recipients on welfare would have on the number of social workers required. Mr. Davis was unable to supply that answer. Senator Washington explained S.B. 428 would target a pilot group of 3,000 so during the first two years of the program that number would be off the welfare roles. He noted there was an additional transitional 12 month period the bill addressed. He also mentioned the federal government in its waiver process mandates a pilot group and funding set aside for additional social workers. Ms. Krenzer asked how many social workers would be eliminated if 3,000 people were removed from welfare during the next two years and another 3,000 in the next four years. Mr. Davis stated it was his understanding the entire state of Nevada had only ten welfare social workers. Ms. Krenzer, for clarification, inquired what a welfare social worker`s case load would be. Mr. Davis replied he did not know and one should distinguish between professional social workers and case workers, or eligibility workers. Ms. Krenzer commented she understood that very well and could he respond to the question. Mr. Davis said he did not know because he did not know how many were currently working nor the current case load. Mrs. Monaghan stated she was closing the hearing on S.B. 428 but that it would be re-opened on Wednesday. The meeting was adjourned at 4:30 p.m. RESPECTFULLY SUBMITTED: Terry Horgan, Committee Secretary APPROVED BY: Assemblywoman Vivian L. Freeman, Chairman Assemblywoman Jan Monaghan, Chairman Assembly Committee on Health and Human Services June 26, 1995 Page