MINUTES OF THE SENATE COMMITTEE ON COMMERCE AND LABOR Sixty-eighth Session May 16, 1995 The Senate Committee on Commerce and Labor was called to order by Chairman Randolph J. Townsend, at 8:00 a.m., on Tuesday, May 16, 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: Beverly Willis, Committee Secretary Scott Young, Senior Research Analyst OTHERS PRESENT: Joe Guild, Lobbyist, Union Pacific Railroad and Nevada Dietetic Association Kay Oring, President, Nevada Dietetic Association Robert Watson, Chief Executive Officer, Vitamin Research Products, Inc. Carol Pruner, The Herb Lady Bob Martin, Lobbyist, Executive Director, Nevada Association of Homeopathic Physicians Lucille Lusk, Lobbyist, State Legislative Liaison, Nevada Concerned Citizens Paula Berkley, Lobbyist, State Board of Chiropractic Examiners Pat Coward, Lobbyist, Nevada Association of Realtors Patsy Redmond, Executive Vice President, Nevada Association of Realtors. Darrell Clark, Attorney, Nevada Association of Realtors Joan Buchanan, Administrator, Real Estate Commission I. R. Ashleman, Lobbyist, Southern Nevada Home Builders Association Kevin Gulliver, R.N., President, Nevada Nurses Association Andra Fjone, Vice President, Nevada Nurses Association Jean Lyon, Secretary, Nevada Nurses Association Sharon Meade, Family Nurse Practitioner Donald Kwalick, State Health Officer, Department of Human Resources Sam McMullen, Lobbyist, Nevada State Board of Nursing Pat Elzy, Associate Director, Planned Parenthood of Northern Nevada Lisa Lilley, Advanced Practitioner of Nursing, Planned Parenthood of Southern Nevada John Jessen, Research Analyst, Southwest Medical Association Janine Sawaya, Chief Operating Officer, Sierra Health Services Judy Zito-Pry, Advanced Practitioner of Nursing, Southwest Medical Association Senator Townsend opened the meeting with the introduction of Bill Draft Request (BDR) 58-1592. BILL DRAFT REQUEST 58-1592: Revise procedures for review of application to close or modify services of railroad agency. First to testify, Joe Guild, Lobbyist, Union Pacific Railroad and Nevada Dietetic Association, came forward to testify, to give reasoning behind this BDR. SENATOR LOWDEN MOVED TO INTRODUCE BILL DRAFT REQUEST 58- 1592. SENATOR AUGUSTINE SECONDED THE MOTION. THE MOTION CARRIED UNANIMOUSLY. * * * * * Senator Townsend then presented BDR 52-2060 to the committee. BILL DRAFT REQUEST 52-2060: Removed prohibition against operation of service station by refiner of petroleum. SENATOR LOWDEN MOVED TO INTRODUCE BDR 52-2060. SENATOR AUGUSTINE SECONDED THE MOTION. THE MOTION CARRIED. (SENATOR NEAL VOTED NO.) * * * * * The next item to be addressed was the presentation of BDR 52- 882. BILL DRAFT REQUEST 882: Makes changes concerning deceptive trade practices. SENATOR SHAFFER MOVED TO INTRODUCE BDR 52-882. SENATOR REGAN SECONDED THE MOTION. THE MOTION CARRIED UNANIMOUSLY. * * * * * Senator Townsend then opened the hearing on Senate Bill (S.B.) 193. SENATE BILL 193: Regulates practice of dietitians. Mr. Guild came forward to testify and introduced Kay Oring, President, Nevada Dietetic Association. Senator Townsend, referring to Exhibit C, explained changes in this amendment. Ms. Oring spoke, noting changes in Exhibit C, and stating why she thinks they are important. Ms. Oring, presented Exhibit D, went on to explain educational requirements for a registered dietitian. Ms. Oring, again referring to Exhibit C, the new amendment, claimed it (the amendment) will only apply to people who wish to call themselves dietitians. She went on to state the amendment does not affect the sale or distribution of food, food materials, dietary products, or dietary supplements. Ms. Oring then referred to Exhibit E, stating she feels this represents a misunderstanding of the amendment. Ms. Oring then referred to Exhibit F, with an explanation of her understanding. Next to testify, Robert Watson, Chief Executive Officer, Vitamin Research Products, Inc., noted he is a member of the National Nutritional Food Association (NNFA). Mr. Watson stated the NNFA feels there are problems with this legislation, noting the NNFA is opposed to operating in the form of an exemption in the practice of disseminating nutritional information and questioned the need for the legislation. Mr. Watson continued, expressing his views and stating he feels this legislation will restrict information. Senator Townsend asked Mr. Watson why he feels this bill has these kinds of restraints. Senator Townsend, Mr. Watson and Senator O'Connell, went on with a comprehensive discussion. Senator O'Connell stated: Unless you have passed the test that allows you and have had the educational 900 hours, etc. and therefore have received your national recognition, as registered [a] dietitian, this bill does not apply to you, period. That's all in the world it says, that you cannot say you are a dietitian, unless you have stood for the national boards. There was further discussion between Mr. Watson, Senator Augustine, Senator Townsend and Senator Regan, with Senator Augustine offering explanation to Mr. Watson. Senator Regan noted statements by Senator Townsend will qualify legislative intent. Senator Townsend stated: The operative clause is at the beginning of the class do they hold themselves out to be a dietitian, or a licensed dietitian. If they do, then you have to be registered with the group. If you don't hold yourself out to be that, hold all the classes you want. You just can't step up to the podium and say I'm something I'm not. That's all the bill says. Senator Regan continued, "The bill is to qualify the registered dietitian, who has a card from a national recognized licensing or certification group." Senator O'Connell stated, "All they want (those requesting the bill) is to have a definition of what a dietitian is, that's all the bill really does." Senator O'Connell asked Mr. Watson if a legislative opinion of S.B. 193, would be helpful. Mr. Watson replied in the affirmative. Carol Pruner, The Herb Lady, came forward noting her concerns are similar to those expressed by Mr. Watson. Once again, Ms. Oring voiced various concerns. Bob Martin, Lobbyist, Executive Director, Nevada Association of Homeopathic Physicians, referring to Exhibit C, voiced his concerns. Mr. Martin stated he feels the exclusion of section 10 of Exhibit C might clarify this legislation. Ms. Oring and Mr. Watson joined in the conversation. Mr. Martin gave several other examples of his concern. Senator O'Connell, once again to help clarify, stated, "That's the whole point. If they are saying they are a dietitian, then they need to be licensed as a dietitian. That's the whole point, Bob [Martin]. Otherwise they need to change their title." At this time, Mr. Guild joined the conversation, stating, "The proponents of this measure would agree to deleting all of section 10 [Exhibit C]." Mr. Watson once again, voiced concerns and reiterated his request for a legal opinion. One more time, Ms. Oring spoke, this time for the record: I would like to correct two errors in perception. Even though the American Dietetic Association and the Commission on Dietetic Registration requires a bachelor's degree, we have 66,000 members and 67 percent of them have advanced degrees. Our organization has more Ph.D's than any other allied health group, except for physicians..........There are now laws in 36 states that either require licensure or certification or entitlement of a registered dietitian. Lucille Lusk, State Legislative Liaison, Lobbyist, Nevada Concerned Citizens, was next to testify. Ms. Lusk gave her views to help clarify this legislation and gave further views, referring to Exhibit C. At this time Senator Townsend closed the hearing on S.B. 193 and opened the hearing on S.B. 344. SENATE BILL 344: Revises provisions relating to licensing of chiropractors and chiropractors' assistants. Paula Berkley, Lobbyist, State Board of Chiropractic Examiners, stated this legislation, in part, had resulted from a series of questions from Senator Lowden. Ms. Berkley gave an explanation. Ms. Berkley presented Exhibit G, (The original is on file at the Research Library.). SENATOR LOWDEN MOVED TO DO PASS SENATE BILL 344. SENATOR SHAFFER SECONDED THE MOTION. THE MOTION CARRIED UNANIMOUSLY. * * * * * At this time Senator Townsend opened the hearing on S.B. 403. SENATE BILL 403: Revises duties of certain persons who are acting in capacity of agent to parties to real estate transaction. Pat Coward, Lobbyist, Nevada Association of Realtors, introduced Patsy Redmond, Executive Vice President, Nevada Association of Realtors, and Darrell Clark, Attorney, Nevada Association of Realtors. Mr. Coward gave an explanation of the legislation. Ms. Redmond stated the purpose of S.B. 403 is to clear up the confusion over agency relationships. Senator Townsend clarified stating, "What we are trying to do is help the consumer understand the licensee's relationship either to another licensee, the property itself, to the group for which they may work, for the broker, all of those interrelationships." Ms. Redmond replied in the affirmative. Ms. Redmond then gave several examples. Senator Regan and Ms. Redmond held further discussion concerning what is covered by disclosure. Senator Lowden and Mr. Clark examined ramifications of an oral agreement. Ms. Redmond, Mr. Coward and Mr. Clark addressed concerns expressed by Senator Neal over protection to the consumer. Mr. Clark noted this legislation is an endeavor to declare and clarify the relationship, so the consumer understands how one individual can work with both sides of a transaction. Joan Buchanan, Administrator, Nevada Real Estate Commission, presented background on the inception of this legislation and presented Exhibit H for clarification. I. R. Ashleman, Lobbyist, Southern Nevada Home Builders Association, was next to testify. Mr. Ashleman stated, although his organization has a few concerns, basically they do support S.B. 403. He went on to note specific problems in section 5 of S.B. 403. The hearing closed on S.B. 403 and opened on S.B. 412. SENATE BILL 412: Revises educational requirements for certification as advanced practitioner of nursing. Kevin Gulliver, R.N., President, Nevada Nurses Association, introduced Andra Fjone, Vice President, Nevada Nurses Association and Jean Lyon, Secretary, Nevada Nurses Association. Mr. Gulliver stated the intent of this legislation "is not to change the scope of practice for advanced practitioners of nursing in any way, but to establish a minimum accepted educational requirement for that type of practice." Mr. Gulliver then presented Exhibit I in support of added training. Ms. Fjone then added her comments. Senator Augustine and Ms. Fjone continued with a review of educational requirements. Next to testify, Ms. Lyon joined the conversation concerning education. Senator Lowden and Ms. Fjone proceeded to explore various educational procedures. Senator Townsend entered the discussion, stating: The current law says [an] advanced practitioner of nursing [has] to [be a] registered nurse, who has completed an educational program designed to prepare a registered nurse....... In other words, the board could draft this requirement and simply say our educational program statute is now a graduate degree of nursing or related field from a college or university accredited by a recognized professional accrediting agency - and that's our new educational program. Mr. Gulliver concurred. Ms. Lyon noted, "This legislation will impact only those nurses who choose to enter into an advanced practice role after January 1, 1998. What we are asking is that we have legislation that would require those nurses who are practicing after 1998 to be prepared with a masters degree in nursing or a related field." Ms. Lyon continued responding to concerns voiced by Senator Neal, regarding this legislation's impact on the consumer/public. Ms. Lyon, Senator Lowden, Senator O'Connell and Ms. Fjone continued with their discussion. Sharon Meade, Family Nurse Practitioner, responded to questions posed by Senator Lowden concerning, in particular, problems and solutions pertaining to rural areas. Ms. Lyon, again commented, this time testimony concerning salaries. Senator Shaffer inquired if a nurse practitioner will identify themselves as such, to which Ms. Fjone's reply was, "Yes." Donald Kwalick, State Health Officer, Department of Human Resources, presented Exhibit J, offering testimony regarding the potential effect on rural areas. Mr. Kwalick attested he has concerns for those who do not have a masters degree, since a number of these are needed in rural areas. Further dialogue continued between Mr. Gulliver and Senator Townsend, concerning the subject of numbers of nurses. Senator Townsend suggested that Mr. Gulliver and others from his group along with Sam McMullen, Lobbyist, Nevada State Board of Nursing, might benefit from conversations regarding problems connected with this proposed legislation. Mr. McMullen clarified for the committee, the fact that there have been public hearings in the past on regulations. At this time, Exhibit K was presented. Next to testify, Pat Elzy, Associate Director, Planned Parenthood of Northern Nevada, presented Exhibit L, Exhibit M and Exhibit N. Ms. Elzy stated her organization opposes S.B. 412. Ms. Elzy stated, "Adding a graduate degree will make a public health problem even worse." Ms. Elzy continued citing Exhibit L, Exhibit M and Exhibit N. Lisa Lilley, Advanced Practitioner of Nursing, Planned Parenthood of Southern Nevada, noted the shortage of advanced practitioners of nursing. John Jessen, Research Analyst, Southwest Medical Association, noted he opposes S.B. 412 and presented Exhibit O, in opposition. Mr. Jessen introduced Janine Sawaya, Chief Operating Officer, Sierra Health Services, and Judy Zito-Pry, Advanced Practitioner of Nursing, Southwest Medical Association. Ms. Sawaya made a number of comments in opposition. Ms. Sawaya voiced several concerns concerning the "grandfather" issue, noting those coming in from out-of-state will not have this option. Ms. Zito-Pry, testified seeking to answer questions posed by Senator Regan pertaining to possible reluctance on the part of some health-oriented organizations to encourage their employees to seek advanced education. Mr. Jessen joined the conversation in an effort to further clarify, noting the company does have a program to encourage education, however the employee must seek this opportunity. At this time Senator Townsend closed the hearing on S.B. 412. There being no further business, the meeting was adjourned at 12:35 p.m. RESPECTFULLY SUBMITTED: Beverly Willis, Committee Secretary APPROVED BY: Senator Randolph J. Townsend, Chairman DATE: Senate Committee on Commerce and Labor May 16, 1995 Page