MINUTES OF THE SENATE COMMITTEE ON COMMERCE AND LABOR Sixty-eighth Session February 13, 1995 The Senate Committee on Commerce and Labor was called to order by Chairman Randolph J. Townsend, at 9:30 a.m., on Monday, February 13, 1995, in Room 2609 of the Legislative Building, Las Vegas, Nevada. Exhibit A is the Agenda. Exhibit B is the Attendance Roster. COMMITTEE MEMBERS PRESENT: Senator Randolph J. Townsend, Chairman Senator Ann O'Connell, Vice Chairman Senator Sue Lowden Senator Kathy M. Augustine Senator Raymond C. Shaffer Senator Joseph M. Neal, Jr. COMMITTEE MEMBERS ABSENT: Senator John B. (Jack) Regan (Excused) STAFF MEMBERS PRESENT: Beverly Willis, Committee Secretary Scott Young, Senior Research Analyst OTHERS PRESENT: Donald S. Kwalick, M.D., State Health Officer, State Division of Health Bernard Feldman, M.D., Chairman, Governor's Maternal and Child Health Advisory Board, State Board of Health Larry Matheis, Executive Director, Nevada State Medical Association Major James Ronan, Pediatric Nurse Practitioner, United States Air Force Mary Koithan, Ph.D., American Nurses Association, Congress of Nursing Practice Wallace Henkelman, R.N., Clinical Nurse Specialist, Nevada Nurses Association Andra Fjone, Pediatric Nurse Practitioner, Nevada Nurses Association Suzanne Denton-Pratt, Legislative Cochairman, Nevada Chapter, National Association of Social Workers Shirley Cox, Board of Directors, Nevada Chapter, National Association of Social Workers Darcy Vanderpool, President, Nevada Association for Marriage & Family Therapy, Nevada Mental Health Coalition Chairman Townsend opened by noting testimony had been given on preventative health in the committee for a number of years. Senator Townsend went on to state a solution to the serious cost of health care is to try to keep people from becoming seriously ill. Today's meeting would be dealing not only, with illness in general, but areas of prevention having to do with life style choices. Donald S. Kwalick, M.D., State Health Officer, State Division of Health, was first to testify, stating his specialty is public health and preventative medicine. He went on to say he wanted to give information on what public health is all about and how it fits into preventative services along with what needs to be done if there is going to be true health care reform. At this time, Dr. Kwalick noted his testimony (Exhibit C), would be to highlight the diversity of public health's activities beginning with each of the letters of the words Public Health. Dr. Kwalick gave examples in explanation of Exhibit C. Senator Townsend questioned Dr. Kwalick as to how the figures in Exhibit C were determined. Dr. Kwalick stated by phone, a random dialing method. Again referring to Exhibit C, Dr. Kwalick summarized his thoughts. Senator Lowden questioned Dr. Kwalick regarding the importance of immunizations and asked for information on waivers of immunizations for various reasons. Dr. Kwalick stated in order to control those diseases mentioned in Exhibit C, there needs to be a properly immunized population and these immunizations should start as young as possible. Dr. Kwalick stated he feels current laws are sufficient as far as waivers. He went on to note there might be medical or religious reasons for a waiver of immunization. Senator Lowden, Senator Augustine and Dr. Kwalick had further discussion on the ramifications of mandated immunization and solutions if harm or illness was caused because of the mandated immunization. At this time, Senator Lowden introduced a class from St. Viator's School. Senator O'Connell asked for information from Dr.Kwalick regarding the frequency of testing for mammographic x-ray machines. Dr. Kwalick's answered they are tested annually. He went on to note Nevada is one of the first states to have a certification process and regulations in place, since a federal law had been enacted. He went on to note there should be a certification certificate in evidence. Senator O'Connell then queried Dr. Kwalick on the status of Nevada compared to other tourist-oriented states regarding the figures on smoking and drinking. Dr. Kwalick stated sometimes service employees may have a higher percentage of alcohol use and smoking, but he had no definite figures. Dr. Kwalick answered Senator O'Connell's question regarding Nevada's standing of AIDS and HIV, noting Nevada was in the top 10 as far as incidence. This relates to the numbers of new cases per 100,000 population. There was further discussion regarding these statistics. Referring to the discussion on the waiver of immunization, Senator Neal asked Dr. Kwalick to clarify his statements regarding the quarantine of those who are not immunized. Dr. Kwalick reiterated his belief that those who may choose not to be immunized because of religious or health reasons, should be quarantined in case of an epidemic. Senator Neal then asked Dr. Kwalick how he felt about the role of public health officers. Dr. Kwalick stated he feels there is a need for trained public health personnel at the state and national level to provide leadership relating to the kinds of things that should be done. Senator O'Connell then asked about the resurgence of tuberculosis, wanting to know if it has become a factor in Nevada's health care at this time. Dr. Kwalick stated it has noting, however, it has leveled off. Senator O'Connell then asked whether there is an increase in other sexually transmitted diseases. Dr. Kwalick stated there has been an increase. Next was a presentation by the Nevada Highway Patrol in the form of a film, titled "Red Asphalt III." The film is based on lifestyle results in the state. Before the film, however Senator Augustine introduced the Vice Principal of St. Viators, Sister Elizabeth Sullivan. Bernard Feldman, M.D., Chairman, Governor's Maternal and Child Health Advisory Board, State Board of Health, was next to testify. Dr. Feldman presented his testimony (Exhibit D). Senator Lowden questioned Dr. Feldman, referring to Exhibit D, regarding reconstructive surgery in connection with mastectomy noting this particular type of surgery is often considered optional. Dr. Feldman replied he justified his decision as he thought there are groups of people who have been excluded from the most recent and best advances in medical care the United States has to offer, noting women are one of those groups. Dr. Feldman went on to state he feels health education would set good habits for many years to come. Larry Matheis, Executive Director, Nevada State Medical Association, presented Exhibit E and gave an explanation. Senator O'Connell and Mr. Matheis discussed the impact the transient status of the population has on the figures presented. Mr. Matheis gave further explanation of Exhibit E. Senator O'Connell, Senator Neal and Mr. Matheis had an in-depth discussion regarding Exhibit E, including health care for the indigent. Major James Ronan, Pediatric Nurse Practitioner, United States Air Force, came forward to testify (Exhibit F). Major Ronan stated he is responsible for implementing a program from the Department of Health and Human Services called "Put Prevention in the Practice," for all beneficiaries at Nellis Air Force Base . Major Ronan noted he endorses and recognizes the importance of previous testimony. He went on to state he wanted to concentrate on federal programs, already existing, for prevention and health promotion. Answering questions posed by Senator Lowden as to whether the population at Nellis Air Force Base is healthier than others, Major Ronan noted not necessarily, providers can only do one part. Another part is the responsibility of the consumer as well as the responsibility of society. Senator O'Connell asked Major Ronan for literature on "Put Prevention Into Practice" (Exhibits G, H, I, J) (Originals on file at the Research Library.) Referring to Exhibit F, Senator Neal queried Major Ronan regarding the statement "Critical review of our health system has shown that the reliance on the biomedical model and medical interventions as a health care strategy has failed." Major Ronan replied the statement is true and gave further explanation. There was further discussion on Exhibit F between Senator Neal and Major Ronan. Mary Koithan, Ph.D., American Nurses Association, Congress of Nursing Practice, was next to testify. Dr. Koithan thanked the committee for their attention in bringing to the public's attention the need for primary prevention and the need for disease health promotion. Dr. Koithan presented testimony in the form of Exhibits K, L M, N and O. (Original of Exhibit O on file at the Research Library.) Next to testify was Wallace Henkelman, R.N., Clinical Nurse Specialist, Nevada Nurses Association, presenting Exhibit P. Mr. Henkleman stated he was mainly here today to emphasize his thoughts that registered nurses are qualified to perform preventative care. Mr. Henkelman, referring to Exhibit P, gave his reasoning. Mr. Henkelman noted the State of Iowa, using registered nurses to educate Medicaid recipients on the appropriate use of health resources saved $4 million during the first 2 years of this program. The program is called the "Recipient Health Education Program for Medicare." Mr. Henkelman asked to be included in further discussions on health care reform and preventive care. Mr. Henkelman identified programs his organization would be interested in, with an increase in resources, for Senator O'Connell. Andra Fjone, Pediatric Nurse Practitioner, Nevada Nurses Association, testified next. Ms. Fjone stated she is only one of several nurses providing primary care to children. Ms. Fjone stated her goal is to prevent children from making poor health decisions. Ms. Fjone noted in her work, she runs into the spectrum of health care problems. She stated the bottom line for her is, "any changes, in the health care system, any legislation that comes out of the legislature this year, must absolutely include nurse practitioners as primary health care providers. It is absolutely critical. We spend at least 90 percent of our day working with patients to help them be healthier. Without our services, I think the statistics would look even more grim to you than they do today." Senator O'Connell asked for information on programs for senior citizens. Ms. Fjone noted there are a number of programs. It was noted there are several projects in progress. There was a discussion between Senator Neal and Ms. Fjone. Ms. Fjone stated legislative encouragement of some community-based centers of care would help their efforts. Senator Lowden asked for explanation of services provided by the nurse practitioner, i.e., immunization shots, blood pressures. Ms. Fjone stated she is a nurse practitioner, and according to state law, this means she can prescribe medicines, etc. Ms. Fjone went on to note most of the time, doctors are supportive of her efforts. There was other discussion regarding these matters between Senator O'Connell, Senator Neal and Senator Augustine. Ms. Fjone passed out Exhibit Q for the committee's review. There was also discussion regarding the decline in the number of school nurses. Suzanne Denton-Pratt, Legislative Cochairman, Nevada Chapter, National Association of Social Workers, introduced Shirley Cox, Board of Directors, Nevada Chapter, National Association of Social Workers, who stated she has a hand in policy formulation and deals with ethical issues. Ms. Cox gave an overview on the duties of social workers. Darcy Vanderpool, President, Nevada Association for Marriage & Family Therapy, Nevada Mental Health Coalition, testified, presenting Exhibits R and S. Senator Townsend noted there is a stigma attached to the phrase "mental health" and asked Ms. Vanderpool for information on preventative processes. Ms. Vanderpool noted there is much that can be done, i.e., screening to help people become aware of stress levels. Also, by establishing school programs to emphasize a change of lifestyle can lead to prevention of domestic violence and prevention of child abuse. Ms. Vanderpool stated one way to help is to have people accept they have emotions and to teach constructive expression. Ms. Vanderpool gave several examples. Ms. Denton-Pratt noted individuals need to know, on a preventive basis, better choices can be made, however, these same individuals should realize they have to be accountable for these choices. There were more examples given by both Ms. Denton-Pratt and Ms. Vanderpool. Senator Townsend announced those remaining who still wished to testify would be first on the list at tomorrow's meeting. There being no further business, the meeting was adjourned at 12:45 p.m. RESPECTFULLY SUBMITTED: Beverly Willis, Committee Secretary APPROVED BY: Senator Randolph J. Townsend, Chairman DATE: Senate Committee on Commerce and Labor February 13, 1995 Page