MINUTES OF THE SENATE COMMITTEE ON COMMERCE AND LABOR Sixty-eighth Session February 14, 1995 The Senate Committee on Commerce and Labor was called to order by Chairman Randolph J. Townsend, at 8:30 a.m., on Tuesday, February 14, 1995, in Room 2609 of the Grant Sawyer State Office Building, Las Vegas, Nevada. Exhibit A is the Agenda. Exhibit B is the Attendance Roster. COMMITTEE MEMBERS PRESENT: Senator Randolph J. Townsend, Chairman Senator William O'Connell, Vice Chairman Senator Sue Lowden Senator Kathy M. Augustine Senator Raymond C. Shaffer Senator John B. (Jack) Regan Senator Joseph M. Neal, Jr. STAFF MEMBERS PRESENT: Beverly Willis, Committee Secretary Scott Young, Senior Research Analyst OTHERS PRESENT: Chester Chin, H.M.D., Physician Barbara Paulsen, Nevada Dietetic Association, Program Director, Dairy Council of Utah/Nevada Margaret A. Riedl-Galli, RD., C.D.E., Nevada Dietetic Association, President, Southern Nevada Dietetic Association Debra Meyer, Registered Dietitian, Nevada Dietetic Association Stephanie Tyler, Lobbyist, Nevada State Chiropractic Association Jess Askeroth, Physician, Immediate Past President, Nevada State Chiropractic Association David Rowles, Director of Administration, Clark County Health District Otto Ravenhold, M.D., Chief Health Officer, Clark County Health District Diana Bond, Board Member, Past President Nevada Pharmacists Association, Nevada State Board Pharmacy Rachelle F. Spiro, Immediate Past President, Nevada Society of Hospital Pharmacists and Nevada Pharmacists Association Keith J. Tierney, President-Elect, Planned Parenthood of Southern Nevada Shelley Fisher, Director of Public Affairs, Planned Parenthood of Southern Nevada Scott Sells, Ph.D., Nevada Association for Marriage and Family Therapy and Nevada Mental Health Coalition Elizabeth C. Richitt, Ph.D., Psychologist Alice A. Molasky, Commissioner, Insurance Division, Department of Business & Industry James C. Smith, Deputy Attorney General, Insurance Division, Department of Business & Industry Edward Reed, Deputy Attorney General, Insurance Division, Department of Business & Industry Marie Saldo, Vice President Government Affairs, Sierra Health System Fred Hillerby, Consultant, Washoe Health Systems Senator Townsend opened the meeting, noting, those who had not been able to testify yesterday, would testify first at today's meeting. First to testify, the Senator introduced Dr. Chester Chin, who expressed his appreciation for the chance to talk about preventive medicine. He stated he has been in practice for 42 years, with 27 years in Las Vegas. Dr. Chin noted he is licensed in acupuncture, chiropractic homeopathy and Oriental medicine. He indicated that practitioners emphasize the importance of good nutrition, balanced diet, proper physical exercise, manipulation, and natural medicine to ensure optimum efficiency of the defense mechanism to prevent disease from occurring. He noted that acupuncture had been used in China for 5000 years, and when former President Nixon went to China in 1972 and saw what acupuncture could do for the sick people, he brought back that information and shortly thereafter, in 1973, acupuncture was legalized in Nevada. He continued, stating that acupuncture and Oriental medicine can treat all types of pain, internal medical problems, and chemical abuses. He referred to testimony given the day before concerning the treatment of alcoholism, obesity, cancer, and drunk driving and feels sure the committee would agree that preventive medicine should be covered. Dr. Chin indicated that currently, there are about 54 acupuncture clinics in New York City engaged in the treatment of drug addictions and that County District Judge Lehman has requested to have such a program (Exhibit C). Dr. Chin continued, stating that chiropractic homeopathy is based on treating the nerve system by timely spinal manipulation. He pointed out that our nation has spent over $1 billion a year in the treatment and surgery for such ailments and in addition incurred many lost hours in national productivity. He stated that homeopathy is based on the premise that disease can be cured by stimulating the defense system. Dr. Chin concluded that traditional medicine, at best, can only take care of 50 percent of the ailing population and the other 50 percent have to look for alternative medicine. He remarked there has been a resurgence in recent years for homeopathic remedy because it is safe and cost effective and emphasized he is not here to compete against traditional medicine. Closing, he said alternative medicine should be classified as a complementary medicine along with traditional medicine. Senator Townsend, referring to an article in the morning paper regarding a prison official who noted that medical analysis indicates that one of the things that should be looked at in prison populations is certain behaviors may be triggered by improper diet and there could be a chemical imbalance. Senator Townsend asked if Dr. Chin treated chemical imbalance. Dr. Chin indicated that his daily practice might include acupuncture on the ear lobes to control the craving for alcohol, drugs, cigarette smoking, or for weight reduction. Senator Regan inquired about the length of time the acupuncture needle can be left in an individual. Dr. Chin replied needles are usually in about 15 to 20 minutes, maximum. However, he noted there are some procedures where the needle can be imbedded in a person overnight, or as long as a week. Next to testify, Barbara Paulsen, Nevada Dietetic Association, Program Director, Dairy Council of Utah/Nevada, indicated she is a registered dietitian. Ms. Paulson presented testimony from Exhibits D and E. Senator O'Connell noted that Ms. Paulson mentioned that 36 states have licensure for dietitians, or have some other form of recognition and asked what the other recognition might be. Ms. Paulsen replied there is licensure in most states, but some states have what is called a title act where the definition of dietician, or in some cases the word nutritionist has been legally defined. Ms. Paulson noted even if there is not a licensure procedure, a person cannot call themselves a dietician or a nutritionist unless they meet that legal definition. Margaret A. Riedl-Galli, RD., C.D.E., Nevada Dietetic Association, indicated she is a registered dietitian with a certification in diabetes education. She said after she has educated patients, many of them ask why physicians do not provide this information. Ms. Riedl-Galli indicated she may spend as much as 1-« hours with a patient and noted often physicians do not have the time, or they may not have the answers. Ms. Riedl-Galli stated in many cases diabetes treatment is reimbursed, but one problem with the elderly population is Medicare will pay for one education session and if these people have diabetes over a number of years, trends in management may change and reimbursement is not available for frequent follow-up. She stressed follow-up is very important, because most people only retain 20 percent of information on a first education basis. She then addressed key cases in Exhibit F. (Original is on file at the Research Library.), concentrating on what she has experienced on an individual basis with patients in terms of health prevention and cost containment. Debra Meyer, Registered Dietitian, Nevada Dietetic Association, noted her specialty is work as a cardiovascular dietitian. Ms. Meyer gave an overview of Exhibit G. Ms. Meyer pointed out, cardiovascular disease is the number one killer of adults in the United States today and nutrition has a direct implication. Then a discussion followed between Senator Townsend, Senator Lowden, Ms. Meyer, and Ms. Paulson regarding various aspects of dietetic education. Ms. Paulson indicated good nutritional habits extend the quality of life which enables all to be a more productive part of society. She went on to note early nutrition intervention can have large savings in terms of health care costs, productivity and good health itself. Ms. Paulson went on to state she would encourage any legislation regarding health care reform to include nutrition and medical therapy. Also, that registered dietitians be seen as qualified professionals to provide those services. Senator Augustine questioned the role played by dietitians in hospitals as far as counseling. The answer is, currently dietitians are now becoming more involved in nutrition education, assistance and behavior change. They have also found working with individuals on a one-to-one basis works. At this time Senator Neal stated for the record that "Mrs. Neal is a member of the group of dietitians." Stephanie Tyler, Lobbyist, Nevada State Chiropractic Association, thanked the committee for their participation in all health care issues. Ms. Tyler then introduced Jess Askeroth, Physician, Immediate Past President, Nevada State Chiropractic Association, who presented Exhibit H. Dr. Askeroth concurred with remarks made by those who have already testified. Dr. Askeroth noted he feels the responsibility of a person's health is that person's responsibility. He noted that research is playing a big part to back up the need for good nutrition and good exercise. He went on to give further explanation regarding his views. Dr. Askeroth stated not one group has all of the answers for all of the problems. David Rowles, Director of Administrative Services, Clark County Health District, testified next stating a goal of the Clark County Health District is to deal with preventive health issues in such a manner that will make Nevada citizens as well as visitors happier and healthier. Mr. Rowles presented Exhibits I, J, K, L, M and N, stating these exhibits are a summary of some of the activities and programs based in the Clark County Health District. He noted there was testimony given previously regarding the availability of data on preventive health issues and Mr. Rowles stated for the record: "There is not a lack or a dearth of data; we have plenty of data. What we are trying to do is get it in more recognizable fashion to decision makers, such as yourself, so that might assist you in looking at preventive health programs." Mr. Rowles went on to outline various programs supported by the Clark County Health District. Mr. Rowles then introduced Otto Ravenhold, M.D., Chief Health Officer, Clark County Health District. Dr. Ravenhold referred to Exhibit K and L, giving detailed explanations. Dr. Ravenhold gave an overview on immunizations, noting standards are constantly changing. Senator Lowden questioned Dr. Ravenhold, observing immunizations are mandated for school children, yet, for a variety of reasons, some parents do not want immunizations for their children. Dr. Ravenhold noted while he prefers immunizations, however, if parents object, especially on a philosophical basis, he will grant an exemption. Referring to Exhibits I through N, there was further discussion between Senator Lowden, Senator Augustine, Senator Regan and Dr. Ravenhold on immunization and various other programs available through the Clark County Health District. Next to testify Diana Bond, Board Member, Past President Nevada Pharmacists Association, Nevada State Board Pharmacy, stated she and her associates wanted to speak about the aspect of pharmaceutical care and medications as they relate to health care prevention. Ms. Bond presented Exhibits O, P, Q and R. Ms. Bond provided the committee with various statistics pertaining to prescriptions and drug use. Rachelle F. Spiro, Immediate Past President, Nevada Society of Hospital Pharmacists and Nevada Pharmacists Association, spoke next, referring to Exhibits O, P, Q and R. Ms. Spiro continued with a synopsis of these exhibits. Senator Neal asked if there are any pharmacies that are actually owned by drug companies, in Nevada, to which Ms. Spiro replied "not to my knowledge." Keith J. Tierney, President-Elect, Planned Parenthood of Southern Nevada and Shelley Fisher, Director of Public Affairs, Planned Parenthood of Southern Nevada, testified next. Mr. Tierney stated the concept of preventative medicine is new. Mr. Tierney then presented Exhibit S, giving a summary. Senator O'Connell and Mr. Tierney discussed monies available for planned parenthood. Senator Townsend and Ms. Fisher discussed the part education plays in planned parenthood. Ms. Fisher stated educational facilities are being used by men as well as women. Ms. Fisher noted for Senator O'Connell, planned parenthood is not allowed to give information to students below college level in the Clark County District. Ms. Fisher stated, however, their organization is allowed to give information to college students. Scott Sells, Ph.D., Nevada Association for Marriage and Family Therapy and Nevada Mental Health Coalition, stated his concerns regarding licensure of marriage and family therapists and their ability to be compensated. Next to testify, Elizabeth C. Richitt, Ph.D., Psychologist, presented Exhibits T and U. Dr. Richitt stated she feels mental health treatment is cost effective. She went on to note preventative aspects to mental health treatment in terms of early diagnosis and treatment. Senator O'Connell queried Dr. Richitt regarding updated information on violence as it is displayed on television and movies and how it relates to gangs and high crime statistics. Dr. Richitt stated information on this subject will be sent to the committee. After a short break, Senator Townsend commented on the Employee Retirement Income Security Act (ERISA), in particular on Exhibits V and W, memos on ERISA and a Comparison of Nevada's Mandated Health Care Benefits with the Hawaiian Prepaid Health Care Plan, prepared by Scott Young, Senior Research Analyst. First to testify after resumption of the hearing, was Alice A. Molasky, Commissioner, Insurance Division, Department of Business & Industry. Ms. Molasky presented Exhibits X and Y, giving an explanation. Ms. Molasky gave clarification on Exhibit X to Senator Townsend. Ms. Molasky went on to elaborate on Exhibit Y. At this time, Ms. Molasky answered several questions posed by Senator Neal on legal aspects of ERISA. Ms. Molasky stated: Our agency does aggressively enter into all areas in which we are able to under ERISA and seek to abandon the abuses where we can. At this time Ms. Molasky introduced James C. Smith, Deputy Attorney General, Insurance Division, Department of Business & Industry, and Edward Reed, Deputy Attorney General, Insurance Division, Department of Business & Industry. Mr. Smith commented on a number of ploys bogus organizations will use in order to circumvent proper insurance practices. Mr. Reed concurred with Mr. Smith, giving a number of examples. Mr. Smith, Ms. Molasky, Senator Townsend and Senator Neal continued with a detailed discussion on ERISA. Marie Saldo, Vice President, Government Affairs, Sierra Health System, and Fred Hillerby, Consultant, Washoe Health Systems introduced themselves. Ms. Saldo presented Exhibits Z and AA. (Original of Exhibit AA is on file at the Research Library.) Referring to Exhibit Z, Mr. Hillerby gave a detailed explanation. Again, referring to Exhibit Z, Ms. Saldo gave further explanation. Mr. Hillerby noted he has no proposals, at this time, and presented the exhibits in the hope they might be used as a resource for future legislation. He went on to state present insurance laws may need to be reexamined. Senator Townsend closed the meeting by stating "One question will be, is there a double standard for health insurance in the state and how do we get around that." There being no further business, the meeting was adjourned at 12:20 p.m. RESPECTFULLY SUBMITTED: Beverly Willis, Committee Secretary APPROVED BY: Senator Randolph Townsend, Chairman DATE: Senate Committee on Legislative Affairs and Operations February 14, 1995 Page