MINUTES OF THE SENATE COMMITTEE ON HUMAN RESOURCES AND FACILITIES Sixty-eighth Session June 26, 1995 The Senate Committee on Human Resources and Facilities was called to order by Chairman Raymond D. Rawson, at 2:25 p.m., on Monday, June 26, 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 Kathy M. Augustine Senator Joseph M. Neal, Jr. Senator Bob Coffin Senator Bernice Mathews COMMITTEE MEMBERS ABSENT: Senator Sue Lowden, Vice Chairman Senator Maurice Washington GUEST LEGISLATORS PRESENT: Assemblyman William Z. Harrington, Assembly District No. 2 Assemblywoman Gene Wines Segerblom, Assembly District No. 22 Assemblyman Dennis Nolan, Assembly District No. 13 Assemblywoman Vonne S. Chowning, Assembly District No. 28 Assemblyman Mark A. Manendo, Assembly District No. 18 STAFF MEMBERS PRESENT: Kerry Carroll Davis, Senior Research Analyst, Legislative Counsel Bureau Linda Chapman, Committee Secretary Mary Gavin, Committee Secretary OTHERS PRESENT: Henry Etchemendy, Executive Director, Nevada Association of School Boards Debbie Cahill, Director, Legislative Affairs, Nevada State Education Association Carolyne Edwards, Lobbyist, Clark County School District Mary Peterson, Superintendent of Public Instruction, State Board of Education Yvonne Sylva, Administrator, Health Division, State Board of Health Janine Hansen, President, Nevada Eagle Forum Bruce Alder, Division of Child and Family Services, Department of Human Resources Bill Welch, Executive Director, Nevada Rural Hospital Project Fred Hillerby, Lobbyist, Washoe Health Systems, and Associated Pathology Labs Chairman Rawson opened the hearing on Assembly Bill (A.B.) 610. ASSEMBLY BILL 610: Requires department of education to conduct study of need for certain required courses of study. (BDR S-1877) Assemblyman William Z. Harrington, Assembly District No. 2, explained the merits of the bill to the committee, and presented them with a list of curriculum mandates (Exhibit C) imposed by Nevada and other western states. He asserted Nevada has more curriculum mandates than any western state. He stated this bill attempts to provide for the State Department of Education to examine which mandates are really necessary, and develop a policy as to how mandates should be developed. He said he believes the decision to impose mandates should be made at the local level in consultation with the State Department of Education. He advised the drafting of this bill was a cooperative effort between the State Department of Education, the Teachers' Union, the local school boards, and the supervisors' and principals' organization. Mr. Harrington pointed out there is no fiscal note attached to the bill. Henry Etchemendy, Executive Director, Nevada Association of School Boards, expressed their support for A.B. 610. Debbie Cahill, Director, Legislative Affairs, Nevada State Education Association (NSEA), expressed NSEA's support for A.B. 610. Carolyne Edwards, Lobbyist, Clark County School District, told the committee she wants to go on the record with a quote by Assemblywoman Vonne Chowning, before the Assembly Committee on Ways and Means, relative to this bill: At first...there was some very frightening testimony, but this effort...before you now is evidence of a lot of people who have worked together to come to a conclusion that will be good for everybody. Mary Peterson, Superintendent of Public Instruction, State Board of Education, said the State Board of Education believes A.B. 610 represents a reasonable compromise. Chairman Rawson closed the hearing on A.B. 610 and opened the hearing on A.B. 659. ASSEMBLY BILL 659: Establishes procedures pursuant to which person may choose not to be resuscitated in event of cardiac or respiratory arrest. (BDR 40-2071) Dr. Harrington told the committee A.B. 659 originated with Assemblywoman Gene Wines Segerblom, Assembly District No. 22, who had a friend who passed away and was resuscitated against her wishes because the documentation of her wishes was not available at the time she was resuscitated. He said the bill attempts to mirror other states' legislation where people are allowed to obtain wristbands with instructions of "do not resuscitate." He said this will allow those with terminal illnesses to obtain a medically recognized wristband indicating they are "do-not- resuscitate" (DNR) patients, so if they have an out-of-hospital cardiac or respiratory arrest, medical personnel will be able to immediately recognize them as such, and follow their wishes. Dr. Harrington explained those type of events often occur when people are away from their documented paperwork, and they are treated against their wishes. He insisted the wristband does not supersede any other living will; it only allows them the option to wear a wristband if they so choose. Chairman Rawson advised Dr. Harrington that Assemblyman Dennis Nolan, Assembly District No. 13, has proposed amendments to the bill and asked him if he is aware of those amendments, and, if so, if he has any objections to the amendments. Dr. Harrington replied he is aware of the amendments, and while he has no specific objections to them, he feels they are unnecessary, and the bill could be more easily processed without them. Mrs. Segerblom thanked Dr. Harrington for the technical presentation of her bill. She added wristbands which indicate DNR orders are strictly voluntary and can be removed at any time, but can prevent terminally ill patients from incurring unnecessary medical bills. Senator Coffin asked Dr. Harrington if the Assembly had extensive hearings on this bill. Dr. Harrington replied they had a couple of hearings and a couple of work sessions. He said the Health Department had concern that the wristband would supersede a living will, and that everyone would have to have a wristband, and wanted to clarify it would be optional. He maintained the first reprint of the bill reflects the clarification on those issues. Senator Coffin asked if any attorneys testified relative to family members making a decision of this nature for a senile person. Dr. Harrington explained that concern is the reason the bill states: "A doctor, a mentally competent person, or the legal guardian for another person in consultation with one of three groups: the Health Department, an attorney, or a physician, must apply the wristband." Senator Coffin asked Dr. Harrington if nurses, or representatives of nursing homes testified before the Assembly. Dr. Harrington replied, "Not specifically, although they were informed, and our two co-chairpersons are nurses." Mrs. Segerblom informed Senator Coffin that Otto Ravenholt, M.D., and representatives of the county and state health boards were present at every hearing on the bill. Yvonne Sylva, Administrator, Health Division, State Board of Health, testified the purpose of this legislation is to provide an easy and accurate identification method of DNR patients for pre-hospital providers, such as ambulance attendants who respond to an individual's home, and the intent of the patient is that there be no resuscitation performed. She asserted this bill does not change existing practices regarding the establishment of DNR orders for persons without a terminal illness located within a nursing home. Ms. Sylva advised the committee the State Board of Health assisted Mrs. Segerblom and the Legislative Counsel Bureau in drafting this bill, and if it continues to include only those persons who are terminally ill in a pre-hospital setting, the Health Division can manage the program without a fiscal note. Mr. Nolan withdrew his amendments to the bill in the interest of expediting the bill. Senator Neal asked Mr. Nolan if this bill may conflict with recent legislation which makes assisted suicide illegal. Mr. Nolan said that question will probably be ultimately answered in the Supreme Court, but suggested there is a distinction between suicide and the refusal of life sustaining procedures which may end up bankrupting a family. Chairman Rawson told Senator Neal "life resuscitating procedures" means cardiopulmonary resuscitation or a component of cardiopulmonary resuscitation, and stated "the qualified patient" is defined in of Nevada Revised Statutes (NRS) 449.485: "A qualified patient means a patient that is 18 years of age, who has executed a declaration, and who has been determined by the attending physician to be in a terminal condition." Chairman Rawson asked Mr. Nolan if that is not currently done in the hospital setting where a physician leaves a DNR order. He surmised this bill alleviates guesswork on the part of emergency medical personnel who may encounter a patient is that condition. Mr. Nolan confirmed Chairman Rawson's observation, and added the wristband will make the identification of DNR patients easier in an emergency setting, nursing home, or convalescent setting. He maintained it will provide the information a paramedic needs when faced with a critical decision as to how to respond to a crisis. Chairman Rawson summarized this bill does not affect DNR orders in a hospital setting which are already defined in the law, but rather gives emergency personnel notice of the patient's desire in the instance of cardiac or respiratory arrest. Mr. Nolan concurred. Senator Augustine referred Dr. Harrington to page 1, section 4, of the bill and asked if the DNR order from the physician is only put into effect if the patient has requested it. Dr. Harrington replied in a non-hospital setting the DNR order is determined by the patient's desire, but in the hospital physicians do occasionally make DNR orders based on medical need regardless of the patient's wish because physicians are not required to provide futile medical care against what they know is reasonable practice. Dr. Harrington elucidated this bill applies only to resuscitation in an arrest situation, and does not address any other specific application of medical treatment. He explained if paramedics arrive at the scene and a patient is in distress, but not arrest, they would do anything necessary to relieve their distress. Senator Augustine referred Dr. Harrington to page 3, section 16, lines 47 and 48, pointing out it does not state "and" or "or" so she assumes both of those items must be in place: "(a) observes the do-not-resuscitate identification bracelet," and, "(b) is given an oral or written do-not-resuscitate order by a physician." She asked Dr. Harrington whether both of those conditions must exist. Dr. Harrington replied it should probably state "or," but if either of those conditions exist it would be sufficient. Senator Augustine asked Dr. Harrington if an oral order would leave the physician "wide open." [sic] Dr. Harrington replied if a physician is present, he has the legal right to make a DNR order for a patient if the patient is under his care, but reiterated this bill does not address that issue. Senator Augustine asked Dr. Harrington if there is not some liability in that. Dr. Harrington replied there is always liability. Janine Hansen, President, Nevada Eagle Forum, told the committee Nevadans have the right to refuse life-prolonging medical treatment, and in the living will one can state they want food and water but do not want extraordinary means [employed to sustain life]. She opined this bill simply allows people to make decisions concerning their own lives. Chairman Rawson closed the hearing on A.B. 659, and opened the hearing on A.B. 679. ASSEMBLY BILL 679: Authorizes division of child and family services of department of human resources to distribute interest and income earned from money deposited into certain gift accounts to fund special activities for children in foster care. (BDR 38-1644) Assemblywoman Vonne S. Chowning, Assembly District No. 28, told the committee her husband was a foster child in his youth, and is presently an advocate of youth activities. She said youth activities were his salvation when growing up. She explained she wanted to do something this session to help foster children in Nevada, and contacted the Division of Child and Family Services to see what she could do. She said they thought the children should have input, and this legislation was initiated from a panel of foster children who advised they could use assistance in funding of extracurricular activities. Mrs. Chowning presented the committee with written testimony of Erika DeFlyer (Exhibit D), who served as Mrs. Chowning's intern, which shows the research Erika did within her family relative to extracurricular activity expense. She opined this bill, although not wholly adequate to provide the funding necessary to cover the type of expenses listed in Exhibit D, is a start. Mrs. Chowning advised the committee this bill has the support of the Division of Child and Family Services, evidenced by Exhibit E, and asked for committee support of the bill. General discussion ensued relevant to distribution of the funds. Senator Augustine asked Mrs. Chowning if the Southern Nevada Children's Home was closed. Bruce Alder, Division of Child and Family Services, Department of Human Resources, answered in the affirmative, and explained the funds referred to in the bill are a gift fund donated on behalf of the Southern and Northern Nevada Children's Homes. He said there is approximately $431,000 in the fund which is just "sitting there." He said the Division of Child and Family Services would like to see this bill pass which would allow the interest income on that money to be spent on behalf of the foster children for the purpose described by Mrs. Chowning. Mr. Alder advised the committee he has approximately 15 years' experience in managing the gift fund money. He said the use of the money to allow children to be involved in youth activities is invaluable in keeping them out of trouble. He emphasized proper management of the funds and encouraging the children to earn part of the money for those activities is critical to success. Chairman Rawson closed the hearing on A.B. 679, and opened the hearing on A.B. 663. ASSEMBLY BILL 663: Provides school district may authorize use of property of district for commercial advertising. (BDR 34-1387) Assemblyman Mark A. Manendo, Assembly District No. 18, presented the committee with a newspaper article (Exhibit F) which brought to his attention the possibility of raising funds for textbooks through advertising. He explained this bill is permissive as to who participates, but the subject of the advertising is somewhat restricted in that it will not allow for: the advertisement of any type of violence, firearms, alcohol, tobacco; attacks on religion or race; anything which negatively impacts the schools; political advertising; or any inappropriate forms of entertainment. Senator Coffin asked Mr. Manendo if he is sure that the funds raised in this manner will be used for the intended purpose. Mr. Manendo replied his staff and the committee provided for the money to be held in a separate account. Chairman Rawson stated the committee will request an opinion from the finance staff. Mr. Manendo told the committee the intent of the bill is to generate additional revenue for the purchase of textbooks and laboratory equipment. Senator Coffin asked if this bill would allow for the use of Channel 1 in the schools. Mr. Manendo replied that issue was not discussed in the Assembly committees, but advised that schools currently accept advertising fees for sports programs and billboards at the baseball fields, etc. Chairman Rawson closed the hearing on A.B. 663, and opened the hearing on A.B. 709. ASSEMBLY BILL 709: Specifies persons who may obtain results of laboratory tests and authorizes licensed nurses to perform certain laboratory tests. (BDR 40-1389) Bill Welch, Executive Director, Nevada Rural Hospital Project, presented the committee with a packet of letters (Exhibit G) in support of A.B. 709. He told the committee this bill allows certain persons to obtain laboratory results, and is crucial to medical care in the rural counties. He testified the second issue the bill deals with is point of care testing which authorizes nurses to continue performing certain lab functions without requiring additional certification or licensing. Chairman Rawson stated he believes the committee already processed this bill. Fred Hillerby, Lobbyist, Washoe Health Systems, and Associated Pathology Labs, confirmed Chairman Rawson's observation. He said Washoe Health Systems and Associated Pathology Labs asked Assemblyman Neighbors if they could use A.B. 436 as a vehicle to address this point-of-care issue, he agreed, and this committee passed that bill, A.B. 436. Mr. Hillerby stated Mr. Neighbors came to him about a week ago, and told him he did not believe A.B. 436 was going to pass, and advised him he may need to find another vehicle. He told the committee that is why it is now included in A.B. 709. He pointed out sections 6 and 7 in A.B. 436 are exactly what they asked for. He explained, in amending A.B. 709, Washoe Health Systems and Associated Pathology Labs gave them the same language contained in A.B. 436, but in drafting sections 9 and 10 of A.B. 709, the language was changed to the degree that it presents a problem for both the Bureau of Health Facilities and Nursing, and Washoe Health Services and Associated Pathology Labs. He said the current problem is that if A.B. 436 passes, this bill will change what A.B. 436 accomplishes, and will not be what anybody wants. He explained they are therefore asking for an amendment to A.B. 709 replacing sections 9 and 10 with sections 6 and 7 of A.B. 436. Mr. Hillerby also proposed an additional amendment (Exhibit H) to A.B. 709. Chairman Rawson closed the hearing on A.B. 709, and opened the hearing on A.B. 122. ASSEMBLY BILL 122: Makes various changes to provisions governing appeals and hearings before state board of health. (BDR 40-852) Yvonne Sylva, Administrator, Health Division, State Board of Health, told the committee that the Health Division, during the last biennium, has taken seriously the edict of the Legislature regarding the necessity to examine the regulations and statutes to evaluate how they affect the Health Division. She said, in doing so, they came up with several "housekeeping" bills. She provided the committee with prepared testimony (Exhibit I) which describes the purpose of the bill. She explained this bill will simplify the bureaucratic process which is currently very inconsistent relative to the time frame within which complaints must be filed and to whom the complaint must be addressed. Chairman Rawson closed the hearing on A.B. 122. SENATOR NEAL MOVED TO AMEND AND DO PASS A.B. 709. SENATOR MATHEWS SECONDED THE MOTION. THE MOTION CARRIED. (SENATORS WASHINGTON, LOWDEN AND AUGUSTINE WERE ABSENT FOR THE VOTE.) * * * * * SENATOR NEAL MOVED TO DO PASS A.B. 679. SENATOR MATHEWS SECONDED THE MOTION. THE MOTION CARRIED. (SENATORS WASHINGTON, LOWDEN AND AUGUSTINE WERE ABSENT FOR THE VOTE.) * * * * * SENATOR NEAL MOVED TO DO PASS A.B. 659. SENATOR COFFIN SECONDED THE MOTION. THE MOTION CARRIED. (SENATORS WASHINGTON, LOWDEN AND AUGUSTINE WERE ABSENT FOR THE VOTE.) * * * * * SENATOR NEAL MOVED TO DO PASS A.B. 610. SENATOR MATHEWS SECONDED THE MOTION. THE MOTION CARRIED. (SENATORS WASHINGTON, LOWDEN AND AUGUSTINE WERE ABSENT FOR THE VOTE.) * * * * * Regarding A.B. 122, Chairman Rawson asked Ms. Sylva if the passage of this bill gives the Health Division the sole authority to eliminate regulations. Ms. Sylva replied this bill allows the State Board of Health to adopt and/or amend the current regulations. It does not give the authority to the Health Division as an administrative body. She said the State Board of Health has a hearing process that which gives the public an opportunity to review and comment on any proposed regulation. SENATOR NEAL MOVED TO DO PASS A.B. 122. SENATOR COFFIN SECONDED THE MOTION. THE MOTION CARRIED. (SENATORS WASHINGTON, LOWDEN AND AUGUSTINE WERE ABSENT FOR THE VOTE.) * * * * * ASSEMBLY BILL 584: Creates advisory subcommittee on health care planning to provide advice to legislative committee on health care. (BDR 40-1061) SENATOR COFFIN MOVED TO AMEND AND DO PASS A.B. 584. SENATOR NEAL SECONDED THE MOTION. THE MOTION CARRIED. (SENATORS WASHINGTON, LOWDEN AND AUGUSTINE WERE ABSENT FOR THE VOTE.) * * * * * SENATE BILL 87: Revises provisions governing minimum number of day of school per year. (BDR 34-741) Chairman Rawson said several committee members fought very hard to keep the school time measured in minutes, but he has no problem with changing it to hours, if it is kept to an equivalent of the same number of days. He said it may mean there would be a fewer number of days, but more than the usual number of hours, and would allow a shift to year round schools and other things. Henry Etchemendy, Executive Director, Nevada Association of School Boards, told the committee this bill is very important to certain districts around the state relative to other than year round schools because there are other applications. Chairman Rawson asked Mr. Etchemendy to address the concern that this allows schools to require less time in school, and that we are going in the wrong direction in doing this. Mr. Etchemendy replied they would not be going in the wrong direction because it actually provides for a greater amount of instructional contact time, because in the amendment which proposed "an equivalent or greater" time, they asked to strike the words "an equivalent or." Chairman Rawson appointed Senator Coffin, Senator Adler and himself to the second conference committee on S.B. 87. SENATE BILL 36: Requires development of program to track prescriptions for controlled substances filled by pharmacies. (BDR 40-973) Chairman Rawson asked Senator Coffin to check with Mr. Hillerby to see if the amendment is in order. He further asked the committee if there is any objection to concurring on the amendment. The committee voiced no objection. SENATE BILL 85: Revises provisions governing the suspension or expulsion of a pupil who possesses a dangerous weapon or firearm. (BDR 34-656) Chairman Rawson advised the proposed amendment is too complicated to deal with in a hurried fashion, and said he will look into it further before taking action. SENATE BILL 161: Consolidate office of Nevada commissioner for veteran affairs. (BDR 37-154) SENATOR NEAL MOVED TO CONCUR WITH AMENDMENT NO. 1006 TO S.B. 161. SENATOR MATHEWS SECONDED THE MOTION. THE MOTION CARRIED. (SENATORS WASHINGTON, LOWDEN AND AUGUSTINE WERE ABSENT FOR THE VOTE.) * * * * * ASSEMBLY BILL 367: Requires boards of health to avoid conflicts with statutory provisions governing general improvement districts when adopting regulations concerning disposal of sewage. (BDR 40-955) Chairman Rawson advised the committee the Assembly refused to concur on Amendment to A.B. 367. He asked the committee whether they wished to recede. SENATOR NEAL MOVED TO DO NOT RECEDE. SENATOR COFFIN SECONDED THE MOTION. THE MOTION CARRIED. (SENATORS WASHINGTON, LOWDEN AND AUGUSTINE WERE ABSENT FOR THE VOTE.) * * * * * There being no further business before the committee, Chairman Rawson adjourned the meeting at 4:10 p.m. RESPECTFULLY SUBMITTED: Linda Chapman, Committee Secretary APPROVED BY: Senator Raymond D. Rawson, Chairman DATE: Senate Committee on Human Resources and Facilities June 26, 1995 Page