MINUTES OF THE SENATE COMMITTEE ON HUMAN RESOURCES AND FACILITIES Sixty-eighth Session June 16, 1995 The Senate Committee on Human Resources and Facilities was called to order by Chairman Raymond D. Rawson, at 3:00 p.m., on Friday, June 16, 1995, in Room 226 of the Legislative Building, Carson City, Nevada. Exhibit A is the Agenda. Exhibit B is the Attendance Roster. COMMITTEE MEMBERS PRESENT: Senator Raymond D. Rawson, Chairman Senator Sue Lowden, Vice Chairman Senator Maurice Washington Senator Kathy M. Augustine Senator Joseph M. Neal, Jr. Senator Bob Coffin Senator Bernice Mathews GUEST LEGISLATORS PRESENT: Assemblywoman Vivian Freeman, Assembly District No. 24 Assemblywoman Jan Evans, Assembly District No. 30 STAFF MEMBERS PRESENT: Kerry Carroll Davis, Senior Research Analyst, Legislative Counsel Bureau Mary Gavin, Committee Secretary Linda Chapman, Committee Secretary OTHERS PRESENT: John Sarb, Administrator, Division of Child and Family Services, Department of Human Resources Bill Hamilton, Rehabilitation Specialist, Office of Community Based Services, Rehabilitation Division Paul D. Gowins, Representative, Community Based Services, Nevada Rehabilitation Division, Nevada Opinion Leaders Forum Janice Pine, Lobbyist, St. Mary's Health Network, Inc. Debbie Cahill, Lobbyist, Director, Legislative Affairs, Nevada State Education Association Dana Balchunas, Registered Nurse, Student Health Services, Washoe County School District Carolyne Edwards, Lobbyist, Legislative Representative, Clark County School District Elizabeth A. Livingston, Nevada Women's Lobby The meeting opened as a subcommittee meeting due to lack of a quorum. The hearing opened on Assembly Bill (A.B.) 491. ASSEMBLY BILL 491: Revises provisions governing imposition of administrative sanctions against child care facilities. Assemblywoman Vivian L. Freeman, Assembly District No. 24, said some things happened in Reno regarding child care where the owners of the facility were not providing a safe environment for the children in that facility. She said upon learning of this, and based on previous experience she had when working on a bill on intermediate sanctions for nursing home operators, she and John Sarb, Administrator, Division of Child and Family Services, Department of Human Resources, discussed what could probably be done at the state level to make sure such facilities provide a safe environment. A.B. 491 is the result of their collaborative effort. Mrs. Freeman pointed out that the bill provides a number of regulations of things the bureau will do. "Essentially," she said, "it sets up a process whereby the state is given the ability to monitor and to review child care facilities. If a facility is not meeting specific criteria, then there are intermediate sanctions. Previously, the bureau could slap them on the wrist or close them down. A.B. 491 provides the Division of Child and Family Services with the ability to do something positive about noncompliance." Mrs. Freeman said she wanted the bill to prohibit smoking in all child care facilities, but because of the "Mom and Pop" operations in the rural areas where the child care centers are in private homes, smoking is allowed, with some restrictions. Also, Mrs. Freeman said one thing in the bill that was questioned on the floor is the penalty, which is on page 1, line 11, "...penalty of not more than $1,000 per day for each violation." Mrs. Freeman said the committee members felt that was appropriate because there are a number of areas where the operators of child care facilities can make the necessary changes before it gets to the point of penalizing them. Another thing taken care of in committee, Mrs. Freeman said, was the part about the hearings and the notice and so on in section 3.5, and Mr. Sarb has worked that out with language that is satisfactory. Mrs. Freeman said the vote for A.B. 491 was unanimous in committee, so the concerns of all members have been addressed. John Sarb said: As Mrs. Freeman indicated, the ability to impose intermediate sanctions against child care facilities and foster homes is important to the division. It was a recommendation which resulted from a federal audit of such facilities in Nevada. The federal auditors highlighted the fact that the division has no intermediate sanction ability in child care. The situation that would be remedied by having intermediate sanctions is one that does not occur too frequently, but it is a real nuisance when it does, and that is when the division has an operator who has several violations, and the division asks that these be corrected. When the division representative comes back to check, these violations have been corrected, but now they find several more. So what happens over time is that the operators are consistently out of compliance, but never with the same kinds of violations. It is not enough perhaps to go to revocation. The division does not like to do that, but absent some kind of intermediate sanction, those operators are going to operate in a substandard fashion. The chairman asked Mr. Sarb for an example of things for which a child care facility might be fined $1,000 a day. Mr. Sarb said: The regulations are defined in the bill. For example, a facility that does not have immunization records on the children. The division will tell them to get these records, and when the division representative goes back again, the immunization records are fine, but there are other health violations now, or they are over capacity or the staffing ratio is not appropriate. If the division finds someone blatantly and continuously out of compliance on a single issue, that is when the division might consider suspension or revocation. But when they are just always out of compliance on a variety of issues, then intermediate sanctions are appropriate. The division is not interested in closing people down. At the same time, if they are always operating in a substandard fashion, then the division's hands are pretty much tied at the present time. Chairman Rawson asked, "What size facilities are you talking about?" Mr. Sarb replied, "It could be from one child up to facilities having more than 100 children at any given time." Chairman Rawson said this is such an important area, and he feels the bill is somewhat heavy-handed. If the division has the ability to levy a fine of $1,000 a day, then the division can put somebody out of business. It may be that the division does not intend to do that, but he said the problems must be serious in order to warrant such a fine. Mr. Sarb said it is true a fine of $1,000 a day could put somebody out of business and in short order. The problem right now is that the division's only option is to put them out of business or allow continual substandard compliance with the regulations. This is certainly not fair to the children and is not fair to other operators that do comply with the regulations. The chairman said there are regulations relating to the bureaucracy of keeping records and so on, and there are regulations having to do with direct health issues. He said he can see the one being an immediate cause for concern, and the other where the division will want to take corrective action, but not to put the operator out of business. At this time, a quorum was present, and the committee moved to full status. Senator Lowden spoke of a bill pending with the Senate Committee on Taxation that would give some leeway to the day care centers for the purposes of a business tax because they are so heavily regulated in terms of how much staff they are required to have. They have to pay tax for every person there, so this is a familiar issue to her. She said what the Senate Committee on Taxation has heard repeatedly from the day care owners is that they are so regulated now they can barely make ends meet. In the end, they compete with city or county day care centers that are cheaper and subsidized. Other than banking and gaming, Senator Lowden said, she is not aware of any other industry as highly regulated as day care centers, and she is not comfortable with giving them any more of a burden. She said she would not want to deter or prevent anyone from opening a day care center because of over-regulation and because there is so much need for them by working mothers. Senator Mathews said she does agree with Senator Lowden, and pointed out that she has grandchildren and definitely wants no harm to come to them. She feels there may be overreaction because one person has done something wrong, and everybody has to pay for it. The children are the ones who suffer. Senator Mathews said if a day care facility is going to be charged $1,000 a day penalty, it is far better to just close them down because all of that cost is going to be passed on to the parents. Senator Mathews said she is really for the safety of children, but she could not support a measure that would penalize a day care facility so heavily. Mr. Sarb said he is no fan of regulation; he does not like writing them, and the only thing worse is enforcing them. He pointed out that section 3 on page 2 of the bill makes it clear that those regulations have to be incrementally more severe for repeated or uncorrected violations and provides for less severe sanctions of applicable statutes or regulations. He said he does not envision a circumstance in these regulations when there is a first offense anybody could commit that would, by itself, get them a $1,000 fine. He said he just could not imagine that anyone is going to see a $1,000 fine. Mr. Sarb continued, saying clearly there are many child care operators, particularly family care homes, where $1,000 a day is out of the question. At the same time, there are centers operating in this state where $1,000 may be worth it. There are child care operators in this state who are listed in Fortune 500, and $1,000 a day is not a big deal for them. Senator Mathews said it is her contention if the child care center is violating the regulations, close them down. If there are safety issues involved, if the children are in danger, if the operators have to pay this kind of a fine, then they should be closed because the children are not safe. She said Fortune 500 or not, they should be closed down if they are not abiding by the regulations. The chairman advised that earlier in the session, a number of divorced fathers came before the Legislature asking that all regulations be eliminated on child care facilities because the cost has been driven up so high. He said the Legislature did not comply with their request, but the concern is real. Mr. Sarb said of all the areas in which the division is involved in regulation, the child care business is surely the most difficult. In some cases, regulations have been added over time without having reviewed them, and he thinks it is time to review all the regulations. Mr. Sarb stated further that those regulations come from three directions, not simply his division, as there are fire codes and health codes. Clark and Washoe county ordinances are more stringent then state law and cannot be less stringent than state law. Mr. Sarb pointed out day care facilities are in scarce supply, and having to fine or close some of them down would certainly not help the situation. The hearing was closed on A.B. 491, and the hearing was opened on Assembly Bill (S.B.) 584. ASSEMBLY BILL 584: Creates advisory subcommittee on health care planning to provide advice to legislative committee on health care. Bill Hamilton, Rehabilitation Specialist, Office of Community Based Services, Rehabilitation Division, presented for the record a letter and packet of materials on this bill from Donny Loux, Chief, Office of Community Based Services, Rehabilitation Division, Department of Employment, Training and Rehabilitation, (Exhibit C), and testified in support of A.B. 584 for Ms. Loux and himself, as follows: Let me first thank the committee for taking up this bill and applaud the collaborative effort this bill represents. The bill recommends jointly working together to address the issue of health care reform for people of all ability levels. Health care obviously is an issue to all Nevadans, and to the disabled in the community in particular, this is a very vital issue. It is even more acute for those of us in the disability community than for the rest of the population. As a state employee, I am very fortunate in having a very reasonable health care package, but in spite of having a good health care package, I still pay about $3,000 to $4,000 a year out-of-pocket, and I know plenty of other people who pay $4,000 to $6,000, $4,000 to $8,000 or $4,000 to $10,000 a year out of their pockets for health care. Therefore, this again represents to the disability community a very serious issue. Obviously, for anybody who has to pay these amounts of money beyond what health insurance covers, such costs are a disincentive to hold jobs and to contribute to society in the ways we would prefer, such as myself and such as my colleague, Paul Gowins. Our office of Community Based Services has been carrying out a research project on health care issues and is available to this committee, as well as to the Assembly committee, to assist in the collaborative effort this bill represents. Our phone number and chief's name is on the 2-page letter which is at the top of the package, Exhibit C, and we invite you to call us at any time. Thank you for the opportunity to present my statement, and we welcome the opportunity to work together on meaningful health care reform. Thank you very much. Paul D. Gowins, Representative, Community Based Services, Rehabilitation Division, Nevada Opinion Leaders Forum, testified that forum has been involved in many issues dealing with health care reform, cost containment and community issues. He said this bill provides an opportunity for those with disabilities to give input into a new system that will meet their needs. Those people with disabilities feel this bill is a litmus test for a good quality system, and they will apply any effort needed to move A.B. 584 forward and make it a reality for Nevada. Mr. Gowins said he feels A.B. 584 will be very beneficial for those with disabilities. Senator Lowden said this bill is to establish a subcommittee on health care planning, and asked if there is already a committee on health care planning. Chairman Rawson responded affirmatively. Senator Lowden questioned why legislation is needed for this, and she felt the existing committee could appoint a subcommittee. Chairman Rawson said, "They probably could. If this bill were to fail, the health care committee could go ahead. It would depend on who the chairman is this next session and whether or not the chairman wants to go ahead with health care reform." Senator Lowden asked Chairman Rawson if he is the chairman this session, and he responded affirmatively. Senator Lowden asked if there was ever a request for a subcommittee. Chairman Rawson explained that the committee came forward with the idea of a subcommittee. A subcommittee was formed on rural health care issues, and the committee is developing in that direction with a number of subcommittees. Senator Mathews asked if a subcommittee is appointed, will the members need travel money. The chairman said he thought they would get per diem. Senator Mathews asked if the existing health care committee could not address these concerns. Chairman Rawson said all of the issues are very complex, and the six people on the committee cannot be spread far enough to get into all the issues before them. He indicated there has been a tendency to isolate two or three members of the committee on a subcommittee. Mr. Hamilton said this is a rewritten piece of legislation. The original bill did not specifically mention the disabled community. This rewrite does incorporate that community. Mr. Hamilton said as long as the collaborative effort is carried out, the disabled community is not fussy about how it is done. Assemblywoman Jan Evans, Assembly District No. 30, testified the question of appointing a subcommittee was raised on the Assembly side, as well. She said Chairman Rawson has answered a part of the question, and the other part is there is always an agenda for that committee. There are a number of other things the committee has to do regarding health care issues. Mrs. Evans said the reason for the subcommittee is primarily to take some of the work load off the committee, as there is only so much a committee can do in the interim period because they do not meet on a regular basis. The question was raised on the Assembly side as to how long the subcommittee would function. Mrs. Evans said she does not object to sunsetting and thinks a time frame should be established. This subcommittee will carry a heavy load, and she does not see it sunsetting for perhaps 4 to 6 years. Senator Mathews noted the bill asks for 21 members. Mrs. Evans said they looked to other states working with health care reform for some sort of a format for the subcommittee. It was ascertained that the entire group meets frequently only in the early stages to set an agenda and define tasks that need to be taken care of, and subgroups are appointed to handle the different tasks. The subcommittee thereafter may meet only occasionally. Chairman Rawson asked about the fiscal note on A.B. 584, and Mrs. Evans said there is a hospital assessment that has funded the work of the health care committee. There will be a salary and per diem for legislators on the subcommittee and staff, but the subcommittee members will have to be responsible for their own expenses. Consideration will be given for payment for the assistance of consultants. Chairman Rawson pointed out the subcommittee can accept grants, gifts and donations, and Mrs. Evans concurred. Senator Lowden asked for clarification. She said she understood from what Mrs. Evans said that only the legislators will be paid, and the other subcommittee members will be responsible for their own expenses. Both the chairman and Mrs. Evans confirmed this as correct. Senator Lowden asked again why the appointment of a subcommittee called for legislation. Mrs. Evans said some legislative authority is needed for the subcommittee to function effectively and carry out assigned tasks. Chairman Rawson said there is a question about appointing nonlegislative members and in what official capacity they could work. However, he said, the rural subcommittee was appointed without legislation, and the same thing could be done here. Mrs. Evans concurred. Senator Mathews said the legislation may give a little more authority and respect to the subcommittee. Mrs. Evans advised there was discussion on the Assembly side about the work of the subcommittee and, as a result, some changes or amendments have been proposed (Exhibit D), most importantly as follows: The bill as written asks for the appointment of the subcommittee to be done by the Legislative Commission, and everyone agrees with that. It has been suggested, because this is such a large undertaking, that the majority leader of the Senate and the co-speakers of the Assembly make recommendations for the members to serve and, further, going back to the magnitude of the task, it has been suggested instead of having a chairman there be co-chairmen. Senator Augustine asked if this means the chairman of the full committee and the chairman of the subcommittee act as co- chairmen, or will two other people be picked as co-chairmen. Mrs. Evans said it would be the latter; two other people will be picked. Senator Augustine said it seems logical to her that the vice chairman of the full committee serve as co-chairman of the subcommittee. Janice Pine, Lobbyist, St. Mary's Health Network, Inc., said the network supports this bill, and she gave the following example of why the network feels the subcommittee is necessary: The health care industry, managed care, welfare and Medicaid, all of those things are undergoing the possibility of significant changes in the next few years. Putting a body like this in place now will offer an opportunity for some interaction with community groups. The subcommittee would be an excellent forum to interact with counterparts in Clark County and the rural counties throughout the state and position Nevada to more quickly deal with the issues of health care reform. Chairman Rawson pointed out that people in the communities have not had a forum to input into the policies of health care reform, and they would like to be able to do so. The subcommittee will give them an opportunity to do that. The hearing was closed on A.B. 584 and opened on Assembly Bill (A.B.) 482. ASSEMBLY BILL 482: Extends requirement that school districts develop plan to reduce ratio of pupils to school nurses. Debbie Cahill, Lobbyist, Director, Legislative Affairs, Nevada State Education Association, testified in order to understand what has happened with this bill, it is necessary to go back to 1991, as follows: In 1991, the school nurses joined together to bring forward a concern that is often overlooked in the discussion about funding for school districts. The school nurses are overloaded with work in this state, and there was discussion because they wanted to achieve a ratio by hiring more nurses, putting more nurses on the job. In 1991, the discussion came to an abrupt end on the issue of money because there was no money. With the help of Chairman Rawson, the idea of a study was developed to bring information forward about the ratio of nurses to students in the school districts. The study was presented in 1993 and again in this session for 1995 through the state board from the school districts. The bill that came to this session was the appropriation to hire the nurses needed to achieve this ratio. That bill did not get out of Assembly education. It was for $9 million. It was an appropriation that would have allowed the districts to hire the nurses needed. The nurses, now realizing that just the study alone does not produce the impetus to grant that money, developed a fall-back position to extend the study for one more biennium. I have discussed a possible strategy for the next session with members of the school nurses' association whereby meetings will begin during the interim and with the new, updated information in hand, they will begin working with the administration, as well as with legislative members, to see if this program cannot be funded up front and put in the budget before the session begins. To give you some information about how critical this need is and why we do believe this bill is needed, we have Dana Balchunas from the Washoe County School Nurse Association, and she is going to give you just some brief statistical information about what we are dealing with. Dana Balchunas, Registered Nurse (R.N.), Student Health Services, Washoe County School District, said she is here to convince the committee of something they probably already know, that schools are different today than they were in 1950 or 1980. She said the nurses' needs within the school environment are changing yearly, and the children who are medically fragile and severely impacted by their health needs have arrived at their doorstep. She advised that these children do not leave their problems behind when they arrive at school; they bring them into school. The children who are, in some cases, medically neglected, underinsured or uninsured, medically fragile and needy are now within the neighborhood school classroom. Ms. Balchunas said she would like to briefly go over some statistics (Exhibit E) about that situation because the nurses in Washoe County have just submitted their yearly statistical reports. Actually, she said, the numbers should be higher because many parents choose not to share the children's medical status with the school, for whatever reason. Ms. Balchunas continued for the record: Nurses do not take the place of parents, nor do we take the place of physicians. We are there to lay medically trained eyes on a child, and alert the parent if there appears to be a medical need. We are there in an emergency if a child collapses. But, really, we are no longer the traditional temperature- takers dressed in white nurturing children. We are there to assess their health needs and help the parent meet those needs. Most of the services that are offered to children, once we find a problem, are provided by charitable organizations or intact health insurance or whatever, not by the taxpayer. Out of 45,000 children in the school district, a total of 287 children have cardiac disorders which impair their physical abilities at school or create symptoms that require an R.N.'s attention. About 98 children have diabetes. These children require insulin or some sort of blood sugar monitoring by the R.N. throughout the day. For the 45,000 students in the Washoe County School District (WCSD), there are approximately 24 full-time nurses. We must run to try to meet the needs of those 45,000 children. Approximately 250 children have genetic disorders; half of those are Down's Syndrome children who have mental deficits, cardiac problems, muscle and a whole myriad of other problems that go with Down's Syndrome. These children are in the classrooms. Other problems include 350 children who have seizures during the school day. That means the child loses consciousness and may require hands-on treatment, or just some sort of monitoring to assure the child is safe. There are about 813 children on Ritalin. Ritalin is a drug to control attention deficit disorder. It does come with side effects. Somebody has to look at that child and alert the parent if that child is having a problem due to that medication. There are approximately 1,565 asthmatics who, sometime throughout the year, require nursing intervention. In addition, there are children who require gastrostomy tube feedings, gastric gavage, tracheostomies, colostomy care, catheterization, nebulizer breathing treatments, oxygen and suctioning. I have not gone into the social problems the nurses encounter, but in the best of circumstances, this unhealthy child or a child with health deficits has two loving parents who have a doctor and medical insurance to pay for their needs. This is a rarity; this is a relic. Washoe County, and Nevada in general, has one of the highest uninsured working poor populations in the country. When such parents have a medically fragile child, often there is no way that child's needs can be met. Nurses are there to assess these problems and guide the parents through them, and try to scrape together a charitable means of funding, when necessary. Also, children are screened for glasses, and this often discloses that, in many cases, a child has real problems in that area. Ms. Balchunas then cited in detail several different cases of emergency situations with which she and the other nurses have had to deal. Senator Augustine said she is aware of the shortage of school nurses, and she asked why the appropriation request of almost $10 million was not just reduced to allow the committee to at least get a smaller ratio of nurses to children than the present 1000 to 1. Ms. Cahill said the discussion that took place in the Assembly Committee on Education was that they were there to make the policy statement, so, obviously, they were ready to send the bill right on. The real fear is that the bill would never make it out of ways and means, and even if it is reduced to $1 or $2 million, there is a long waiting list. She said the Assembly Committee on Education felt it is important enough to keep this on the front burner to produce at least one more report to give the nurses the opportunity to work during the interim with the administration. The association has plans to be very active and start contacting the Governor's office to see if the appropriation cannot get built into the budget going into the next biennium so they do not have to deal with it from a disadvantage. In conclusion, Ms. Cahill said the idea is mainly to keep the issue alive, rather than lose the while bill. Senator Augustine said the ratio has been reduced since this legislation started about 4 years ago, and asked Ms. Cahill if she knew what the monetary amount is to reduce the ratio even to 500 to 1. Ms. Cahill responded that to achieve a 1,000 to 1 ratio was where the $9 million was generated. Presently, the ratio is much higher, but 1,000 to 1 is what they are trying to achieve. She said progress has been made, and this bill did alert the districts to the fact that they need to concentrate on getting the ratio down. Ms. Cahill said there are schools in the rural districts where there are no R.N.s. In Clark County, there are some schools where there is no medical personnel, and they have office personnel administering medication or dispensing medication. She pointed out that this issue will not go away. It is an important issue. Senator Augustine said she knows there has been a push for elementary school counselors, and she thinks it is more important to have a nurse in the elementary school than a counselor. She asked if this is being explored. Ms. Balchunas said she is biased toward nursing, but Maslo's hierarchy of needs, which is the model she studied in nursing school, dictates that safety and health are primary. If a child does not have excellent health or good health or adequate health, there is no way that child can learn. She said a counselor could probably counter that by saying if the child's social environment or family environment is not adequate, he cannot learn. Ms. Cahill continued by saying the nurses currently work closely as a team with administrators and teachers, psychologists and counselors, because often children are not supported in their home environment, medically or otherwise. Carolyne Edwards, Lobbyist, Legislative Representative, Clark County School District (CCSD), testified in support of A.B. 482. Ms. Edwards advised that CCSD wholeheartedly endorses this bill and wishes to continue the ongoing battle to get nurses in the schools. Senator Augustine asked when the ratio started to slip. Ms. Edwards said two things happened at the same time. There was a shortage of R.N.s. Hospitals in Las Vegas could not recruit enough to keep up with the demand. Concurrently, there was enormous population growth. Ms. Edwards said the current ratio is 1,700 or 1,800 to 1. It is mainly a growth issue, and it has gotten out of hand. Senator Mathews remarked that the school districts hire any number of medical aides who call themselves nurses. They are not nurses, and many of the things they are doing are illegal and dangerous. Dispensing medications is one of them. The chairman pointed out that now there is a school nurses' association, and they do not hire just anyone. Elizabeth A. Livingston, Nevada Women's Lobby, testified in support of A.B. 482 and urged the committee to pass this bill. Senator Washington asked if the nurses have to call the parents and get their consent before administering medicine and so forth. Ms. Balchunas said the nurses' job is communicating with parents, and the parents need to be informed if the nurse feels a child's health will be impacted by what has happened. She said for little scrapes and cuts, they do not notify the parents; but for something out of the ordinary or that has a definite obvious impact on the child, they always inform the parents. Senator Washington asked what was meant by "obvious"? Ms. Balchunas said "obvious" to the trained eye. Senator Washington asked if that includes any kind of medication, and Ms. Balchunas said, "Yes. We see ourselves as a bridge to the working parent who can't be with the child during the course of the school day. Ideally, the parents would communicate with the school nurses. No screening is done without parental permission." Senator Washington asked further if in everything that is done requiring a medical procedure, parental consent is always obtained? Ms. Balchunas said she could not guarantee that it is every time a Band-Aid is put on, but parental consent is required for any procedure performed by a school nurse, and a physician has to prescribe that procedure as well. She said most parents are very grateful for school nurses. The chairman asked if there were some students on which there may be "no code" orders. Ms. Balchunas replied, "There are a couple, and this requires an agreement between parents, physician and the staff at the school. There are a few cases where the child is considered terminal, and the humane thing is to not resuscitate." The chairman remarked that most people do not realize this. Senator Washington said as a parent, he has a great level of trust in school nurses, and they have been most cooperative in letting he and his wife know what is going on. He advised that both he and his wife work, so that trust factor has to be there. For the most part, he feels the nurses do a great job. Senator Lowden said she would like some clarification on why a bill is needed to do this; why cannot the state board do this without a bill? Obviously, it is agreed and proven that the nurses are needed, and the board knows how much money is needed. Senator Lowden asked, "Why do we need one more year of this bill?" Chairman Rawson advised: The ratio has dropped since the bill was first introduced. By developing a bill like this, it originally brought attention to the shortage of nurses, and the ratio started to change downward. The fear is that by letting it go, the ratio will creep right back up again. Without calling attention to this nurse shortage, there is no attention paid to it. There is no great force of law if there is no funding, but the districts may have some resources they can put into it if they know that it is an issue. The hearing was closed on A.B. 482. SENATOR MATHEWS MOVED TO DO PASS A.B. 482. SENATOR AUGUSTINE SECONDED THE MOTION. THE MOTION CARRIED UNANIMOUSLY. * * * * * The hearing was opened on Assembly Bill (A.B.) 681. ASSEMBLY BILL 681: Revises provisions governing submission of fingerprints used during investigation of person who provides child care. John Sarb testified A.B. 681 was requested by the division to bring them into compliance with the legislative audit finding that noted the current language says fingerprints required for employees in child care facilities will be submitted to the bureau. Mr. Sarb pointed out what the division is doing by A.B. 681 is changing the law to bring it into compliance with current practice. Mr. Sarb pointed out what happens now is there are many, many employees every year who need to have their background checked as they enter employment in the child care industry. The division worked out the procedure with law enforcement agencies when this law first came on the books in the 1980s. Local law enforcement agencies take the applicant's fingerprints and submit them to the criminal history repository for submission to the Federal Bureau of Investigation (FBI). Mr. Sarb said the division does not want to take fingerprints, and to literally comply with the existing law, they would have to do so. What is being done by A.B. 681 is just rewriting the law to comply with the current practice that has the endorsement of law enforcement. The audit subcommittee of the legislative commission has given approval as an appropriate response to that audit finding. Senator Neal said it is his understanding the division will now receive a set of fingerprints as part of the application, and the division will submit them to the criminal history repository. Mr. Sarb said no, and although the existing law says the division should do that, we have never done so. The division does not think it is a good idea for them to take fingerprints. Law enforcement does not think it is a good idea for the division to take fingerprints. The division advises the applicant of the local law enforcement agency where the fingerprints will be taken. The hearing was closed on A.B. 681. SENATOR COFFIN MOVED TO DO PASS A.B. 681. SENATOR LOWDEN SECONDED THE MOTION. THE MOTION CARRIED. (SENATOR MATHEWS AND SENATOR AUGUSTINE WERE ABSENT FOR THE VOTE.) SENATOR NEAL MOVED TO AMEND AND DO PASS A.B. 584. The motion died for lack of second. Chairman Rawson suggested that further action on A.B. 584 and A. B. 482 be postponed for the time being. The meeting was adjourned at 4:30 p.m. RESPECTFULLY SUBMITTED: ____________________________ ___ Mary Gavin, Committee Secretary APPROVED BY: _____________________________________ Senator Raymond D. Rawson, Chairman DATE:________________________________ Senate Committee on Human Resources and Facilities June 16, 1995 Page