The Senate Committee on Human Resources and Facilities was called to order by Chairman Raymond D. Rawson, at 1:50 p.m., on Monday, May 24, 1999, in Room 2135 of the Legislative Building, Carson City, Nevada. Exhibit A is the Agenda. Exhibit B is the Attendance Roster. All exhibits are available and on file at the Research Library of the Legislative Counsel Bureau.

COMMITTEE MEMBERS PRESENT:

Senator Raymond D. Rawson, Chairman

Senator Maurice Washington, Vice Chairman

Senator Mark Amodei

Senator Bernice Mathews

Senator Michael Schneider

Senator Valerie Wiener

COMMITTEE MEMBERS ABSENT:

Senator Randolph J. Townsend (Excused)

GUEST LEGISLATORS PRESENT:

Senator Alice Constandina (Dina) Titus, Clark County Senatorial District No. 7

STAFF MEMBERS PRESENT:

Cynthia Cook, Committee Secretary

OTHERS PRESENT:

Chairman Rawson introduced Assemblywoman Kathryn (Kathy) A. McClain, Clark County Assembly District No. 15. She explained Assembly Concurrent Resolution (A.C.R. 60).

Assemblywoman McClain described the deaf population as a special group of people, with unique needs. A.C.R. 60 urges all school districts in Nevada to provide an environment that recognizes the needs of deaf and hard-of-hearing students. The bill provides basic guidelines for educational personnel and parents to ensure the student receives the appropriate educational program.

Chairman Rawson closed the hearing A.C.R. 60 and opened the hearing on Assembly Joint Resolution (A.J.R.) 24.

Chairman Rawson summarized some issues concerning steroids. He made clear there are many conditions requiring the use of powerful steroids; however, they can have extensive side effects.

Lawrence P. Matheis, Lobbyist, Nevada Medical Association, testified the concept of A.J.R. 24 originated during interim studies, and the association endorses it. The resolution asks Congress to look at Food and Drug Administration (FDA) labeling of products that contain steroids, both over-the-counter (OTC) and prescription. Senator Wiener asked Mr. Matheis about a news release issued by The Consumer Healthcare Products Association (Exhibit C) concerning the negative tenor of the resolution. The document argues there is current labeling required for OTC products containing hydrocortisone. Mr. Matheis answered the intent of the bill is neutral; to assure that those who need to know, realize there is a steroid included in a product. He added, although most drug companies are currently required to label products with the ingredients, sometimes the information is hard to read. Chairman Rawson interjected most retailers are hesitant to put on a warning label that might discourage sales.

Senator Wiener asked if the purpose of A.J.R. 24 is to request all steroid products include an insert relating to the percentage of steroid and possible adverse reactions. Mr. Matheis assured her that is the intent of the resolution.

Jeanne Simmons, Concerned Citizen, voiced support for A.J.R. 24.

Chairman Rawson closed the hearing on A.J.R. 24 and opened the hearing on Senate Bill (S.B.) 549.

Senator Alice Constandina (Dina) Titus, Clark County Senatorial District No. 7, assured the committee S.B. 549 is designed to offer the same protection to employees of medical facilities that is offered to physicians. The bill defines those facilities covered, and the information for which an employee cannot be discriminated against. Senator Titus continued S.B. 549 also provides the remedy for employees who perceive bias. Senator Mathews conceded her support of the concept of S.B. 549, but she wondered why this group is not covered by current "whistle-blower" legislation. Senator Titus answered current legislation generally refers to government agencies, and a representative of the nurses association will explain why it is felt additional protection is needed.

Daniel F. Geary, Lobbyist, Nevada Service Employees Union, SEIU 1107, read testimony in support of S.B. 549 (Exhibit D).

Dorothy Riley, R.N., President-elect of the Nevada Nurses Association, expressed her appreciation to the committee for the opportunity to speak. She then read a prepared statement (Exhibit E) in support of S.B. 549.

Chairman Rawson questioned where complaints would be referred. Mr. Geary said the bill would allow employees to offer complaints to any entity; for example, the media, and state and federal agencies. Ms. Riley added the most expedient body for an employee to file an allegation is the regulatory agency that oversees the facility, but there should be no curtailment of free speech. Chairman Rawson responded there can be a proper way to resolve a problem, but if an employee were to go to the media every time they perceived a problem, that could be damaging and hurtful. He speculated complaints should be reported to an appropriate agency. Mr. Geary would be concerned with restrictions; speech is not currently restricted. He assured Chairman Rawson S.B. 549 does protect the confidentiality of the patient.

Senator Wiener observed methods need to be in place to expedite complaints in the clearest way. Senator Mathews agreed an obvious line of authority is needed or S.B. 549 will not work, but the nursing board is not the proper organization. Senator Mathews expressed the nursing board should only review complaints of negligence by a nurse, and not be involved with subjects such as understaffing, poor housekeeping, and other facility problems. She added reporting to the media often leads to contention. Senator Titus agreed the naming of a unit to disclose information would add to the bill, and Mr. Geary suggested the Bureau of Licensure and Certification which is under the auspices of the Health Division, and a part of the Department of Human Resources, as the intermediary.

Mr. Matheis testified the Nevada Medical Association supports the bill, with the changes suggested today. The association interprets the intention of S.B. 549 is to free the critic of the fear of sanctions, although there are some existing requirements to protect against retribution.

Senator Wiener repeated her thinking the nursing board should be involved. Chairman Rawson said most nurses would not report problems if the board were to be a part of the process.

Assemblywoman Christina R. Guinchigliani, Clark County Assembly District No. 9, informed the committee she had been interested in doing this same type action on the Assembly side. She agreed with Senator Mathews that the nursing board is not the agency to use for this legislation.

Ray E. Bacon, Lobbyist, Nevada Manufacturers Association, pointed out to the committee that S.B. 549 has no protection for the facility with reference to false reports. Chairman Rawson requested Mr. Bacon inform the committee if he had any suggestions to address malicious reporting.

Roberta Gang, Lobbyist, Nevada Womens Lobby, and the National Association of Social Workers, Nevada Chapter, supports S.B. 549.

Senator Titus, in response to Mr. Bacon’s concern, said the fact the complaint is reported to a regulatory agency that then determines if the complaint has merit, is protection enough for the facility.

Mr. Geary said the legislation is particularly important to protect those employees not covered by a union contract.

James L. Wadhams, Lobbyist, Nevada Association of Hospitals and Health Systems, said the association opposes S.B. 549. The uncertainty of where the complaints are to be filed is of utmost importance. Mr. Wadhams said the bill seems to indicate the employees of a health care facility could issue a complaint against the equipment, a physician, another nurse, or an allied health professional. S.B. 549 does not limit itself to circumstances of regulatory concern, and there could be involvement in civil liability. Mr. Wadhams thinks the matter requires additional drafting and review.

Senator Titus, in response to Mr. Wadhams, believes his concerns are covered by wording in the bill, which states:

Mr. Wadhams replied the kinds of concerns that are being raised by proponents of this legislation today indicates the need for careful scrutiny, and the committee should not rush legislation merely because the end of the session is approaching. In answer to Chairman Rawson, Mr. Wadhams said he is available for consultation.

Janice C. Pine, Lobbyist, Saint Mary’s Health Network, conveyed her concerns about S.B. 549. Saint Mary’s Health Network considers confidentiality sacrosanct. Existing peer review and assessment mechanisms should not be subject to disclosure, or professionals could cease to participate. Ms. Pine averred hospitals in Nevada do their very best to provide quality care, and within current law, the means exist to handle situations. To compromise the integrity of straightforward communication would be counterproductive to the mission of hospitals.

Answering Senator Washington, Ms. Pine said St Mary’s Health Network handles complaints by maintaining an open door policy. Hospitals are governed by many entities, and to step away from existing rules and regulations jeopardizes accreditation, certification, and licensing. Ms. Pine continued nurses are duty bound to report irregularities, and surveys are ordered because of anonymous reports. Needed corrections discovered through a survey are made immediately. Ms. Pine said the hospital has internal policies in place, along with an appeal process to handle issues such as retaliation and discrimination.

Bill M. Welch, Lobbyist, Nevada Association of Hospitals and Health Systems, supported Ms. Pine by stating there are numerous mechanisms in place to address the reporting of incidents. The Bureau of Licensure and Certification follows policies and procedures to handle complaints in an anonymous and confidential manner, and many times arrive at a facility unannounced. The surveyors investigate both anonymous and documented complaints, and have access to all records. Mr. Welch continued, to protect union and nonunion personnel who feel they have been wrongly accused, there is a grievance process in hospitals, led by a panel of their peers. The Joint Commission on Accreditation of Healthcare Organizations has a hot line number for anonymous complaints. Mr. Welch stated the Nevada Association of Hospitals and Health Systems opposes S.B. 549.

Senator Titus added, the previous session of the Legislature agreed to protect doctors and some nurses who work for health maintenance organizations, and S.B. 549 asks for that same kind of protection for nurses who work in other medical facilities.

Chairman Rawson closed the hearing on S.B. 549 and opened the hearing on S.B. 435, with Amendment No. 1123.

Assemblywoman Christina R. Guinchigliani, Clark County Assembly District No. 9, explained Amendment No. 1123 changes the required vote of the board of trustees of a school board from a simple majority to a two-thirds majority, and adds the board of trustees must state in writing the reason for its action if it does not adopt a recommendation of the oversight panel.

Assemblywoman Guinchigliani explained Amendment No. 973 changes the effective dates to January 15, 2000 and June 30, 2001 in order to ensure schools have plenty of time to implement the provisions.

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Chairman Rawson opened the hearing on S.B. 519.

Chairman Rawson said the Assembly has refused to recede from its action on the bill, and he requested Senator Amodei to head a conference committee with Senator Wiener and Senator Mathews.

Chairman Rawson opened the hearing on A.B. 238.

Chairman Rawson requested Senator Amodei to head a conference committee with Senator Wiener and Senator Mathews. Chairman Rawson reviewed three items the committee would like to safeguard in A.B. 238: protect the confidentiality of people for the use of their name in the database; have a declaration on a driver’s license as the final document necessary to donate organs; and assign donor organs to Nevada residents first, whenever possible.

Chairman Rawson opened the hearing on A.B. 376.

Chairman Rawson explained the Assembly changed the reference of the "superintendent of schools of the school district" to the "board of trustees." Chairman Rawson requested Senator Washington to head a conference committee with Senator Wiener and Senator Schneider.

The meeting was adjourned at 3:15 p.m.

RESPECTFULLY SUBMITTED:

Cynthia Cook,

Committee Secretary

APPROVED BY:

Senator Raymond D. Rawson, Chairman

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