MINUTES OF THE SENATE COMMITTEE ON COMMERCE AND LABOR Sixty-eighth Session May 12, 1995 The Senate Committee on Commerce and Labor was called to order by Chairman Randolph J. Townsend, at 8:45 a.m., on Friday, May 12, 1995, in Room 227 of the Legislative Building, Carson City, 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 John B. (Jack) Regan Senator Joseph M. Neal, Jr. STAFF MEMBERS PRESENT: Scott Young, Senior Research Analyst Molly Dondero, Committee Secretary OTHERS PRESENT: Jan Needham, Principal Deputy Legislative Counsel, Legal Division, Legislative Counsel Bureau Marsha Berkbigler, Lobbyist, Nevada State Medical Association Anne Davis, Director of State Government Affairs, Nevada Academy of Physician Assistants, American Academy of Physician Assistants Pat Cashill, Lobbyist, Lawyer, Nevada Trial Lawyers Association Jim Webeckes, Legislative Representative, Farmers Insurance Group of Companies A bill draft request (BDR) was introduced. BILL DRAFT REQUEST 54-2066: Provides licensing and regulation of massage as therapy. SENATOR NEAL MOVED TO INTRODUCE BDR 54-2066. SENATOR O'CONNELL SECONDED THE MOTION. THE MOTION CARRIED UNANIMOUSLY. ***** A work session was held on Senate Bill (S.B.) 389. SENATE BILL 389: Authorizes physicians' assistants to prescribe controlled substances. Jan Needham, Principal Deputy Legislative Counsel, Legal Division, Legislative Counsel Bureau, discussed the proposed amendment to S.B. 389. She stated the language would add to section 2 of the bill to allow physicians' assistants to prescribe controlled substances. She said the new language will say, "in strict compliance with all provisions [Nevada Revised Statutes] of chapter 630 of NRS and chapter 633 of NRS." She discussed options for the wording of the proposed amendment. Marsha Berkbigler, Lobbyist, Nevada State Medical Association, explained that when a physician's assistant is working for a physician, the physician is not always in the room with the assistant and overseeing the prescriptions they write. She stated the physician only signs on the prescription, if the prescription is for a controlled substance. She stated if S.B. 389 passes that will no longer be the case. The physician's assistant will no longer have to have the physicians' signature on a prescription for controlled substance. She expressed her concern for this provision. She stated the assistant will have an independent Drug Enforcement Administration (DEA) number. This bill allows nonphysicians to write prescriptions for narcotics in Nevada. Senator Neal asked what is the requirement for a DEA number. Ms. Berkbigler stated there is no listed requirement in federal regulations for a nonphysician. Anne Davis, Director of State Government Affairs, Nevada Academy of Physician Assistants, American Academy of Physician Assistants, stated the DEA has a category for nonphysician prescribers to register with the DEA. The DEA will only track a prescriber if it is allowed by state law. She stated there are 22 states which allow physicians' assistants to write for narcotics. She stated the physician must notify the board in writing when the physician ceases to be the supervising physician. The assistant cannot practice at all without the supervision of the physician. Senator Lowden commented that in a state where she has had experience with using a physician's assistant , the physician may sign prescriptions ahead of time. Ms. Davis stated there is a risk if signed prescriptions are lying around. Senator Lowden suggested using a dual signature system and having the pads for prescription be clearly marked that they are for the use of the physician's assistant. She expressed her concern for giving new DEA numbers to a physicians' assistant. Ms. Davis commented that Texas has been using the dual system, but is now repealing the system because it is too difficult to use effectively. She stated in Texas it is the physicians who want the law repealed because they are uncomfortable with it. Senator Neal asked how the controlled drugs are cared for in an office situation. Ms. Davis stated highly abused substances are kept in locked narcotics cabinets. Senator Neal asked if the same system could be used for a prescription pad with a dual signature required. Senator Shaffer asked if the physician is relieved of responsibility if the physician's assistant can prescribe narcotics. Ms. Davis stated the physicians assistants' practice acts are very clear and the physician is responsible. She stressed the DEA number is used only for tracking. Senator Augustine questioned why a patient who is ill enough to need a controlled substance is not seeing the physician. She stated physician's assistants do not have a pharmacology background. Ms. Davis pointed out the severity of illness is not always the determining factor for the need to medicate. She stated no state which has the legislation similar to that being considered today, has ever repealed the legislation at a later date. Senator Augustine said each state is different with different sets of regulations. Ms. Berkbigler commented language may be added to section 1, subsection 4 to clarify that the issuance of this certificate for the purposes of prescribing controlled substances is due directly to the approval and oversight of the physician. SENATOR NEAL MOVED THAT THE AMENDMENT BE DRAFTED AND PUT INTO THE LAW TO MAKE THE PHYSICIAN RESPONSIBLE FOR THE CERTIFICATE. SENATOR SHAFFER SECONDED THE MOTION. THE MOTION CARRIED. (SENATOR AUGUSTINE VOTED NO.) ***** Senator Townsend thanked Ms. Needham and her staff for the hard work they have contributed to the drafting of legislation during this session. The committee discussed the new language in the amendment for S.B. 385 and approved of the language as drafted. SENATE BILL 385: Makes various changes relating to practice of pharmacy. Ms. Needham stated there is a technical correction to the bill because the original language in statute is not current language. She stated the numbering in the bill will remain the same so that internal references will remain the same. Senate Bill (S.B.) 300 was discussed by the committee. SENATE BILL 300: Allow limitation or denial of insurance claim for medical condition if certain notice or information is not provided to insurer. Pat Cashill, Lobbyist, Lawyer, Nevada Trial Lawyers Association (NTLA), stated when people are in an accident, the first thing they usually want to know is what level of insurance the other driver has. If the insurance is minimal, then people will turn to their own insurance company to file a claim. If the other insurer will not provide a person's insurance company with information needed to process the claim, the claim may be denied. He stressed the need for sharing of information. Senator Augustine stated she does not understand the need to share information. Mr. Cashill stated most automobile policies have medical coverage. With that coverage, medical benefits are paid regardless of who is at fault. He explained if a person is injured by another person in an accident, the claimant's bills will be paid by the insurance company. He stated liability coverage is separate from medical coverage. Underinsured coverage is important to consider in an accident. He stated the amount of coverage is a critical piece of information to the injured person. He stated a requirement for mutual exchange of information is very important to the person who is injured in an accident. Senator Augustine asked how an injured person can prove who is at fault right after an accident, if there is not a trial immediately. Mr. Cashill explained Exhibit C and stated if he is injured in an accident, and if he determines the insurance is inadequate for the needs of himself, and others injured in an accident, then he will contact his insurance agent and initiate a claim. At this point, information should be exchanged. He explained this bill allows him to give the other insurance company all of the information he has on his client, medical and liability. It is a full exchange of information. Senator Townsend commented there are two issues involved in this bill. He stated the new language in section 1 of the bill, suggests the insurance commissioner may require an attorney to provide the information in the case of litigation. Jim Webeckes, Legislative Representative, Farmers Insurance Group of Companies, stated he does not believe the insurance commissioner has the authority to require a plaintiff's attorney to provide that information. Senator Townsend commented the insurance commissioner may have the authority, but may not have chosen to use that authority. He suggested they find out this information. Mr. Cashill stated claimants are not within the jurisdiction of the insurance division unless the claimant files a complaint for unfair practices against a carrier. Senator Townsend discussed a closed-claim study. Mr. Webeckes stated Farmer's Insurance will support a closed- claim study. Mr. Cashill stated he does not have the opinion of NTLA at this time. He stated the scope of a closed-claim study on auto policy will dwarf a closed-claim study on medical malpractice. He doubted the NTLA will object to a closed-claim study. Senator Neal commented the burden of proof is on the individual bringing the lawsuit. He stated since the person must prove their case, why would they need the requested information. Mr. Webeckes stated they are asking to obtain medical records on a timely basis, so that funds may be obtained on an ongoing basis, instead of in a lump sum at the end of the treatment. Senator Neal stated when a person goes to court, they are entitled to the records anyway. Mr. Webeckes stated it can take 2 years to get to court; in the meantime the medical bill must be paid. He commented that most cases are settled out of court. If they do not have any idea how severe someone's injuries are, then they do not know how much to set aside to pay the injuries. He said reserves are set aside in a bank account in anticipation of that claim. He stated, "This bill is not a penalty bill, it is a bill to try to exchange information. Not to punish anybody, not to punish the insured." Senator Lowden asked if other insurance companies are in favor of this bill. Mr. Webeckes stated he has spoken with other insurance company representatives and they are in favor of the bill. Senator Lowden commented if the bill passes as it is written, the insurance companies will save money. She asked what good does that do for her constituents who are paying the highest insurance premiums in the country. She asked what the companies will do for her constituents. Mr. Webeckes stated if they are saving money, and the time comes for a rate increase, they will not get the rate increase approved. Senator Lowden stated she would like to see a rollback of rates. She stated she wants a commitment that there will be no increases and there will be a rollback before she considers voting for the bill. Senator Townsend stated S.B. 300 will be discussed again next Thursday. The hearing was closed at 10:00 a.m. RESPECTFULLY SUBMITTED: Molly Dondero, Committee Secretary APPROVED BY: Senator Randolph J. Townsend, Chairman DATE: Senate Committee on Commerce and Labor May 12, 1995 Page