THE ONE HUNDRED AND TENTH DAY
Carson City (Friday), May 23, 2003
Assembly called to order at 9:52 a.m.
Mr. Speaker presiding.
Roll called.
All present.
Prayer by the Chaplain, Reverend Bruce Henderson.
Somebody has well said that there are only two kinds of people in the world. There are those who wake up in the morning and say, “Good morning, Lord,” and there are those who wake up and say, “Good Lord, it's morning!” Good morning, Lord. Please give us what we need today. May we have enough wisdom to make good decisions, enough trials to make us strong, enough sorrow to keep us humble, enough hope to make us happy, enough compassion to get along with each other, and enough faith to keep us looking to You. Good morning, Lord.
Amen.
Pledge of Allegiance to the Flag.
Assemblyman Oceguera moved that further reading of the Journal be dispensed with, and the Speaker and Chief Clerk be authorized to make the necessary corrections and additions.
Motion carried.
MOTIONS, RESOLUTIONS AND NOTICES
Assemblyman Oceguera moved that the reading of Histories on all bills and resolutions be dispensed with for this legislative day.
Motion carried.
SECOND READING AND AMENDMENT
Assembly Bill No. 548.
Bill read second time and ordered to third reading.
Assembly Bill No. 549.
Bill read second time and ordered to third reading.
Senate Bill No. 416.
Bill read second time and ordered to third reading.
MOTIONS, RESOLUTIONS AND NOTICES
Assemblyman Oceguera moved that Senate Bill No. 168 be taken from its position on the General File and placed at the top of the General File.
Motion carried.
Assemblyman Oceguera moved that Senate Bill No. 319 be taken from the Chief Clerk's desk and placed on the Second Reading File.
Remarks by Assemblyman Oceguera.
Motion carried.
SECOND READING AND AMENDMENT
Senate Bill No. 319.
Bill read second time.
The following amendment was proposed by the Committee on
Commerce and Labor:
Amendment No. 884.
Amend the bill as a whole by deleting section 1, renumbering sections 2 through 10 as sections 12 through 20 and adding new sections designated sections 1 through 11, following the enacting clause, to read as follows:
“Section 1. Chapter 686A of NRS is hereby amended by adding thereto the provisions set forth as sections 2 to 11, inclusive, of this act.
Sec. 2. As used in sections 2 to 11, inclusive, of this act, unless the context otherwise requires, the words and terms defined in sections 3 to 8, inclusive, of this act have the meanings ascribed to them in those sections.
Sec. 3. “Adverse action” means a denial or cancellation of, an increase in any charge for, or a reduction or other adverse or unfavorable change in the terms of coverage or amount of, any insurance, existing or applied for, in connection with any policy.
Sec. 4. “Affiliate” means any company that controls, is controlled by, or is under common control with another company.
Sec. 5. “Consumer credit report” means any written, oral or other communication of information by a consumer reporting agency bearing on the credit worthiness, credit standing or credit capacity of an applicant or policyholder, and which is used or expected to be used or collected in whole or in part for the purpose of serving as a factor to determine:
1. Whether to issue, cancel or renew a policy;
2. The amount of the premium for a policy; or
3. Eligibility for any plan for making payments with regard to a policy.
Sec. 6. “Consumer reporting agency” means any person which, for monetary fees, dues, or on a cooperative nonprofit basis, regularly engages in whole or in part in the practice of assembling or evaluating consumer credit information or other information on consumers for the purpose of furnishing consumer credit reports to third parties.
Sec. 7. “Credit information” means any information that is related to credit and derived from a consumer credit report, found on a consumer credit report or provided on an application for a policy. The term does not include information that is not related to credit, regardless of whether it is contained in a consumer credit report or in an application for a policy, or is used to calculate an insurance score.
Sec. 8. “Insurance score” means a number or rating that is derived from an algorithm, computer application, model or other process that is based in whole or in part on credit information for the purposes of predicting the future losses or exposure with regard to an applicant or policyholder.
Sec. 9. The provisions of sections 2 to 11, inclusive, of this act do not apply to a contract of surety insurance issued pursuant to chapter 691B of NRS or any commercial or business policy.
Sec. 10. An insurer that uses information from a consumer credit report shall not:
1. Use an insurance score that is calculated using income, gender, address, zip code, ethnic group, religion, marital status or nationality of the consumer as a factor, or would otherwise lead to unfair or invidious discrimination.
2. Deny, cancel or fail to renew a policy on the basis of credit information unless the insurer also considers other applicable underwriting factors that are independent of credit information and not expressly prohibited by this section.
3. Base renewal rates for a policy upon credit information unless the insurer also considers other applicable factors independent of credit information.
4. Take an adverse action against an applicant or policyholder based on the applicant or policyholder not having a credit card account unless the insurer also considers other applicable factors independent of credit information.
5. Consider an absence of credit information or an inability to calculate an insurance score in underwriting or rating a policy unless the insurer treats the applicant or policyholder as having neutral credit information, as defined by the insurer.
6. Take an adverse action against an applicant or policyholder based on credit information, unless an insurer obtains and uses a credit report issued or an insurance score calculated within 90 days from the date the policy is first written or renewal is issued.
7. Except as otherwise provided in this subsection, use credit information regarding a policyholder without obtaining an updated consumer credit report regarding the policyholder and recalculating the insurance score at least once every 36 months. An insurer does not need to obtain an updated consumer credit report for a policyholder if:
(a) The insurer is treating the policyholder as otherwise approved by the Commissioner.
(b) The policyholder is in the most favorably-priced tier of the insurer and all affiliates of the insurer.
(c) Credit information was not used for underwriting or rating the policyholder when the policy was initially written.
(d) The insurer reevaluates the policyholder at least once every 36 months based upon underwriting or rating factors other than credit information.
8. Use the following as a negative factor in any insurance scoring methodology or in reviewing credit information for the purpose of underwriting or rating a policy:
(a) Credit inquiries not initiated by the applicant or policyholder, or inquiries requested by the applicant or policyholder for his or her own credit information.
(b) Inquiries relating to insurance coverage, if so identified on the consumer credit report.
(c) Collection accounts relating to medical treatment, if so identified on the consumer credit report.
(d) Multiple lender inquiries, if identified on the consumer credit report as being related to home loans or mortgages and made within 30 days of one another, unless only one inquiry is considered.
(e) Multiple lender inquiries, if identified on the consumer credit report as being related to a loan for an automobile and made within 30 days of one another, unless only one inquiry is considered.
(f) Any credit information that does not reflect the usual credit activity of the applicant or policyholder.
Sec. 11. Before December 31 of each even-numbered year, the Commissioner shall prepare a report to the Governor and the Legislature. The report must address:
1. The operation of sections 2 to 11, inclusive, of this act;
2. The efficacy, necessity and desirability of using credit information in making decisions related to insurance;
3. The impacts upon the residents of Nevada of the continued use of credit information in making decisions related to insurance; and
4. Any additional consumer protections identified by the Commissioner for the consideration of the Legislature.”.
Amend the title of the bill by deleting the first and second lines and inserting:
“AN ACT relating to insurance; restricting the use by an insurer of information included in the consumer credit report of an applicant or policyholder as a basis for making certain determinations and taking certain actions regarding policies of”.
Assemblyman Goldwater moved the adoption of the amendment.
Remarks by Assemblyman Goldwater.
Amendment adopted.
Bill ordered reprinted, re-engrossed, and to third reading.
MOTIONS, RESOLUTIONS AND NOTICES
Assemblywoman Chowning moved that Senate Bill No. 356 be taken from the General File and placed on the Chief Clerk’s desk.
Remarks by Assemblywoman Chowning.
Motion carried.
general file and third reading
Senate Bill No. 168.
Bill read third time.
The following amendment was proposed by the Committee on
Commerce and Labor:
Amendment No. 883.
Amend sec. 6, page 6, line 28, by deleting “district
court.” and inserting: “[district court.] a court of competent
jurisdiction.”.
Amend sec. 12, page 12, line 35, by deleting “district court.” and inserting:
“[district court.] a court of competent
jurisdiction.”.
Amend the title of the bill, fifteenth line, after “circumstances;” by inserting: “revising provisions governing recovery of payments by the Division;”.
Assemblyman Goldwater moved the adoption of the amendment.
Remarks by Assemblyman Goldwater.
Amendment adopted.
Bill ordered reprinted, re-engrossed, and to third reading.
Assembly Bill No. 264.
Bill read third time.
Roll call on Assembly Bill No. 264:
Yeas—34.
Nays—Andonov, Angle, Brown, Gustavson, Mabey, Sherer, Weber—7.
Excused—Mortenson.
Assembly Bill No. 264 having received a constitutional
majority,
Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
Mr. Speaker announced if there were no objections, the Assembly would recess subject to the call of the Chair.
Assembly in recess at 10:04 a.m.
ASSEMBLY IN SESSION
At 10:20 a.m.
Mr. Speaker presiding.
Quorum present.
Assembly Bill No. 297.
Bill read third time.
Remarks by Assemblywoman Leslie.
Roll call on Assembly Bill No. 297:
Yeas—42.
Nays—None.
Assembly Bill No. 297 having received a constitutional
majority,
Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
Assembly Bill No. 418.
Bill read third time.
Roll call on Assembly Bill No. 418:
Yeas—42.
Nays—None.
Assembly Bill No. 418 having received a constitutional
majority,
Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
Assembly Bill No. 441.
Bill read third time.
Remarks by Assemblymen Horne and Geddes.
Roll call on Assembly Bill No. 441:
Yeas—42.
Nays—None.
Assembly Bill No. 441 having received a constitutional
majority,
Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 18.
Bill read third time.
Remarks by Assemblyman Mortenson.
Roll call on Senate Bill No. 18:
Yeas—42.
Nays—None.
Senate Bill No. 18 having received a constitutional majority, Mr. Speaker declared it passed.
Bill ordered transmitted to the Senate.
Senate Bill No. 19.
Bill read third time.
Roll call on Senate Bill No. 19:
Yeas—42.
Nays—None.
Senate Bill No. 19 having received a constitutional majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 46.
Bill read third time.
Roll call on Senate Bill No. 46:
Yeas—42.
Nays—None.
Senate Bill No. 46 having received a constitutional majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
MOTIONS, RESOLUTIONS AND NOTICES
Assemblyman Anderson moved that Senate Bill No. 55 be taken from its position on the General File and placed at the bottom of the General File.
Remarks by Assemblyman Anderson.
Motion carried.
general file and third reading
Senate Bill No. 76.
Bill read third time.
Roll call on Senate Bill No. 76:
Yeas—36.
Nays—Buckley, Giunchigliani, Leslie, Manendo, Mortenson—5.
Not Voting—Angle.
Senate Bill No. 76 having received a constitutional majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 82.
Bill read third time.
Remarks by Assemblywoman Angle.
Roll call on Senate Bill No. 82:
Yeas—42.
Nays—None.
Senate Bill No. 82 having received a constitutional majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 100.
Bill read third time.
Remarks by Assemblyman Brown.
Roll call on Senate Bill No. 100:
Yeas—42.
Nays—None.
Senate Bill No. 100 having received a two-thirds majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 102.
Bill read third time.
Roll call on Senate Bill No. 102:
Yeas—32.
Nays—Angle, Beers, Geddes, Goicoechea, Hardy, Hettrick, Knecht, Mabey, Sherer, Weber—10.
Senate Bill No. 102 having received a constitutional majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 112.
Bill read third time.
Remarks by Assemblywoman Gibbons.
Roll call on Senate Bill No. 112:
Yeas—39.
Nays—Angle, Goldwater, Gustavson—3.
Senate Bill No. 112 having received a two-thirds majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 116.
Bill read third time.
Remarks by Assemblymen Chowning and Beers.
Roll call on Senate Bill No. 116:
Yeas—34.
Nays—Atkinson, Brown, Buckley, Collins, Griffin, Gustavson, Knecht, Marvel—8.
Senate Bill No. 116 having received a constitutional majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 127.
Bill read third time.
Roll call on Senate Bill No. 127:
Yeas—42.
Nays—None.
Senate Bill No. 127 having received a constitutional majority, Mr. Speaker declared it passed.
Bill ordered transmitted to the Senate.
MOTIONS, RESOLUTIONS AND NOTICES
Assemblyman Oceguera moved that Senate Bill No. 136 be taken from its position on the General File and placed at the bottom of the General File.
Motion carried.
general file and third reading
Senate Bill No. 143.
Bill read third time.
Roll call on Senate Bill No. 143:
Yeas—42.
Nays—None.
Senate Bill No. 143 having received a constitutional majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 146.
Bill read third time.
Roll call on Senate Bill No. 146:
Yeas—42.
Nays—None.
Senate Bill No. 146 having received a constitutional majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
MOTIONS, RESOLUTIONS AND NOTICES
Assemblywoman Chowning moved that Senate Bill No. 192 be taken from its position on the General File and placed at the bottom of the General File.
Motion carried.
general file and third reading
Senate Bill No. 147.
Bill read third time.
Roll call on Senate Bill No. 147:
Yeas—42.
Nays—None.
Senate Bill No. 147 having received a constitutional majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 179.
Bill read third time.
Remarks by Assemblywoman Leslie.
Roll call on Senate Bill No. 179:
Yeas—42.
Nays—None.
Senate Bill No. 179 having received a constitutional majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 193.
Bill read third time.
Roll call on Senate Bill No. 193:
Yeas—42.
Nays—None.
Senate Bill No. 193 having received a constitutional majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 196.
Bill read third time.
Roll call on Senate Bill No. 196:
Yeas—42.
Nays—None.
Senate Bill No. 196 having received a constitutional majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 229.
Bill read third time.
Remarks by Assemblyman Hardy.
Roll call on Senate Bill No. 229:
Yeas—42.
Nays—None.
Senate Bill No. 229 having received a constitutional majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 231.
Bill read third time.
Roll call on Senate Bill No. 231:
Yeas—42.
Nays—None.
Senate Bill No. 231 having received a constitutional majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
MOTIONS, RESOLUTIONS AND NOTICES
Assemblyman Oceguera moved that Senate Bill No. 240 be taken from its position on the General File and placed at the bottom of the General File.
Motion carried.
Assemblyman Oceguera moved that Senate Bill No. 309 be taken from its position on the General File and placed at the bottom of the General File.
Motion carried.
general file and third reading
Senate Bill No. 241.
Bill read third time.
Remarks by Assemblymen Anderson, Collins, and Carpenter.
Potential conflict of interest declared by Assemblyman Collins.
Roll call on Senate Bill No. 241:
Yeas—42.
Nays—None.
Senate Bill No. 241 having received a two-thirds majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 246.
Bill read third time.
Roll call on Senate Bill No. 246:
Yeas—42.
Nays—None.
Senate Bill No. 246 having received a constitutional majority, Mr. Speaker declared it passed.
Bill ordered transmitted to the Senate.
Senate Bill No. 247.
Bill read third time.
Roll call on Senate Bill No. 247:
Yeas—42.
Nays—None.
Senate Bill No. 247 having received a constitutional majority, Mr. Speaker declared it passed.
Bill ordered transmitted to the Senate.
Senate Bill No. 262.
Bill read third time.
Roll call on Senate Bill No. 262:
Yeas—42.
Nays—None.
Senate Bill No. 262 having received a constitutional majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
MOTIONS, RESOLUTIONS AND NOTICES
Assemblyman Manendo moved that Senate Bill No. 280 be taken from its position on the General File and placed at the bottom of the General File.
Motion carried.
Assemblywoman Giunchigliani moved that Senate Bill No. 425 be taken from the General File and placed on the Chief Clerk’s desk.
Remarks by Assemblywoman Giunchigliani.
Motion carried.
general file and third reading
Senate Bill No. 288.
Bill read third time.
Remarks by Assemblyman Sherer.
Roll call on Senate Bill No. 288:
Yeas—40.
Nays—Angle, Gustavson—2.
Senate Bill No. 288 having received a two-thirds majority, Mr. Speaker declared it passed.
Bill ordered transmitted to the Senate.
Senate Bill No. 312.
Bill read third time.
Roll call on Senate Bill No. 312:
Yeas—27.
Nays—Andonov, Beers, Brown, Geddes, Gibbons, Goicoechea, Grady, Griffin, Gustavson, Hardy, Hettrick, Mabey, Marvel, Sherer, Weber—15.
Senate Bill No. 312 having received a constitutional majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 320.
Bill read third time.
Roll call on Senate Bill No. 320:
Yeas—42.
Nays—None.
Senate Bill No. 320 having received a two-thirds majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
MOTIONS, RESOLUTIONS AND NOTICES
Assemblywoman Buckley moved that Senate Bill No. 345 be taken from its position on the General File and placed at the top of the General File.
Motion carried.
general file and third reading
Senate Bill No. 345.
Bill read third time.
Roll call on Senate Bill No. 345:
Yeas—42.
Nays—None.
Senate Bill No. 345 having received a constitutional majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 328.
Bill read third time.
Roll call on Senate Bill No. 328:
Yeas—41.
Nays—None.
Not Voting—Goldwater.
Senate Bill No. 328 having received a constitutional majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 329.
Bill read third time.
Roll call on Senate Bill No. 329:
Yeas—42.
Nays—None.
Senate Bill No. 329 having received a constitutional majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 331.
Bill read third time.
Roll call on Senate Bill No. 331:
Yeas—42.
Nays—None.
Senate Bill No. 331 having received a constitutional majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 332.
Bill read third time.
Roll call on Senate Bill No. 332:
Yeas—42.
Nays—None.
Senate Bill No. 332 having received a constitutional majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 336.
Bill read third time.
Roll call on Senate Bill No. 336:
Yeas—42.
Nays—None.
Senate Bill No. 336 having received a constitutional majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
UNFINISHED BUSINESS
Consideration of Senate Amendments
Assembly Bill No. 384.
The following Senate amendment was read:
Amendment No. 718.
Amend section 1, page 1, by deleting lines 1 through 3 and inserting:
“Section 1. Chapter 422 of NRS is hereby amended by adding thereto the provisions set forth as sections 2 to 12, inclusive, of this act.”.
Amend sec. 2, page 1, line 4, by deleting “this chapter,” and inserting: “sections 2 to 12, inclusive, of this act,”.
Amend the bill as a whole by deleting sec. 3 and
renumbering sec. 4 as
sec. 3.
Amend sec. 4, page 1, line 10, by deleting “6” and inserting “7”.
Amend the bill as a whole by deleting sections 5 and 6, renumbering sections 7 and 8 as sections 8 and 9, and adding new sections designated sections 4 through 7, following sec. 4, to read as follows:
“Sec. 4. “Drug Use Review Board” means the Board established pursuant to 42 U.S.C. § 1396r-8(g)(3).
Sec. 5. 1. The Department shall, by regulation, develop a list of preferred prescription drugs to be used for the Medicaid program.
2. The Department shall, by regulation, establish a list of prescription drugs which must be excluded from any restrictions that are imposed on drugs that are on the list of preferred prescription drugs established pursuant to subsection 1. The list established pursuant to this subsection must include, without limitation:
(a) Atypical and typical antipsychotic medications that are prescribed for the treatment of a mental illness of a patient who is receiving services pursuant to Medicaid;
(b) Prescription drugs that are prescribed for the treatment of the human immunodeficiency virus or acquired immunodeficiency syndrome, including, without limitation, protease inhibitors and antiretroviral medications;
(c) Anticonvulsant medications;
(d) Antirejection medications for organ transplants;
(e) Antidiabetic medications;
(f) Antihemophilic medications; and
(g) Any prescription drug which the Committee identifies as appropriate for exclusion from any restrictions that are imposed on drugs that are on the list of preferred prescription drugs.
3. The regulations must provide that the Committee makes the final determination of:
(a) Whether a class of therapeutic prescription drugs is included on the list of preferred prescription drugs and is excluded from any restrictions that are imposed on drugs that are on the list of preferred prescription drugs;
(b) Which therapeutically equivalent prescription drugs will be reviewed for inclusion on the list of preferred prescription drugs and for exclusion from any restrictions that are imposed on drugs that are on the list of preferred prescription drugs; and
(c) Which prescription drugs should be excluded from any restrictions that are imposed on drugs that are on the list of preferred prescription drugs based on continuity of care concerning a specific diagnosis, condition, class of therapeutic prescription drugs or medical specialty.
4. The regulations must provide that each new pharmaceutical product and each existing pharmaceutical product for which there is new clinical evidence supporting its inclusion on the list of preferred prescription drugs must be made available pursuant to the Medicaid program with prior authorization until the Committee reviews the product or the evidence.
Sec. 6. 1. The Department shall, by regulation, establish and manage the use by the Medicaid program of step therapy and prior authorization for prescription drugs.
2. The Drug Use Review Board shall:
(a) Advise the Department concerning the use by the Medicaid program of step therapy and prior authorization for prescription drugs;
(b) Develop step therapy protocols and prior authorization policies and procedures for use by the Medicaid program for prescription drugs; and
(c) Review and approve, based on clinical evidence and best clinical practice guidelines and without consideration of the cost of the prescription drugs being considered, step therapy protocols used by the Medicaid program for prescription drugs.
3. The Department shall not require the Drug Use Review Board to develop, review or approve prior authorization policies or procedures necessary for the operation of the list of preferred prescription drugs developed for the Medicaid program pursuant to section 5 of this act.
4. The Department shall accept recommendations from the Drug Use Review Board as the basis for developing or revising step therapy protocols and prior authorization policies and procedures used by the Medicaid program for prescription drugs.
Sec. 7. 1. The Director shall create a Pharmacy and
Therapeutics Committee within the Department. The Committee must consist of at
least
9 members and not more than 11 members appointed by the Governor based on
recommendations from the Director.
2. The Governor shall appoint to the Committee health care professionals who have knowledge and expertise in one or more of the following:
(a) The clinically appropriate prescribing of outpatient prescription drugs that are covered by Medicaid;
(b) The clinically appropriate dispensing and monitoring of outpatient prescription drugs that are covered by Medicaid;
(c) The review of, evaluation of and intervention in the use of prescription drugs; and
(d) Medical quality assurance.
3. At least one-third of the members of the
Committee and not more than 51 percent of the members of the Committee must be
active physicians licensed to practice medicine in this state, at least one of
whom must be an active psychiatrist licensed to practice medicine in this
state. At least
one-third of the members of the Committee and not more than 51 percent of the
members of the Committee must be either active pharmacists registered in this
state or persons in this state with doctoral degrees in pharmacy.
4. A person must not be appointed to the Committee if he is employed by, compensated by in any manner, has a financial interest in, or is otherwise affiliated with a business or corporation that manufactures prescription drugs.”.
Amend the bill as a whole by deleting sections 9 and 10 and adding a new section designated sec. 10, following sec. 8, to read as follows:
“Sec. 10. 1. The Department shall, by regulation, set forth the duties of the Committee which must include, without limitation:
(a) Identifying the prescription drugs which should be included on the list of preferred prescription drugs developed by the Department for the Medicaid program pursuant to section 5 of this act and the prescription drugs which should be excluded from any restrictions that are imposed on drugs that are on the list of preferred prescription drugs;
(b) Identifying classes of therapeutic prescription drugs for its review and performing a clinical analysis of each drug included in each class that is identified for review; and
(c) Reviewing at least annually all classes of therapeutic prescription drugs on the list of preferred prescription drugs developed by the Department for the Medicaid program pursuant to section 5 of this act.
2. The Department shall, by regulation, require the Committee to:
(a) Base its decisions on evidence of clinical efficacy and safety without consideration of the cost of the prescription drugs being considered by the Committee;
(b) Review new pharmaceutical products in as expeditious a manner as possible; and
(c) Consider new clinical evidence supporting the inclusion of an existing pharmaceutical product on the list of preferred prescription drugs developed by the Department for the Medicaid program and new clinical evidence supporting the exclusion of an existing pharmaceutical product from any restrictions that are imposed on drugs that are on the list of preferred prescription drugs in as expeditious a manner as possible.
3. The Department shall, by regulation, authorize the Committee to:
(a) In carrying out its duties, exercise clinical judgment and analyze peer review articles, published studies, and other medical and scientific information; and
(b) Establish subcommittees to analyze specific issues that arise as the Committee carries out its duties.”.
Amend sec. 11, page 4, lines 21 and 22, after “Committee” by inserting: “and the Drug Use Review Board”.
Amend the bill as a whole by deleting sections 12 through 14 and renumbering sections 15 through 19 as sections 12 through 16.
Amend sec. 15, page 6, by deleting lines 7 through 10 and inserting:
“Sec. 12. 1. The Department may, to carry out its duties set forth in sections 2 to 12, inclusive, of this act and to administer the provisions of sections 2 to 12, inclusive, of this act:
(a) Adopt regulations; and
(b) Enter into contracts for any services.
2. Any regulations adopted by the Department
pursuant to sections
2 to 12, inclusive, of this act must be adopted in accordance with the
provisions of chapter 241 of NRS.”.
Amend sec. 16, page 6, by deleting line 27 and inserting: “inclusive, 422.001 to 422.410, inclusive, and sections 2 to 12, inclusive, of this act, 422.580, 432.010 to”.
Amend sec. 16, page 6, by deleting line 29 and inserting: “445A.055, inclusive, and all”.
Amend sec. 17, page 7, line 24, after “1.” by inserting: “On or before January 1, 2004, adopt final regulations required to carry out the provisions of this act.
2.”.
Amend sec. 17, page 7, line 27, by deleting “2.” and inserting “3.”.
Amend sec. 17, page 7, line 29, by deleting “1” and inserting “2”.
Amend sec. 18, page 7, by deleting lines 35 through 41 and inserting: “Committee, so that the terms of the members are staggered, half of the members to serve initial terms of 1 year and the other half of the members to serve initial terms of 2 years.”.
Amend sec. 18, page 7, line 44, after “Therapeutics Committee” by inserting: “and the Drug Use Review Board”.
Amend sec. 19, page 8, by deleting line 3 and inserting:
“Sec. 16. This act becomes effective upon passage and approval for the purpose of adopting regulations by the Department of Human Resources and on July 1, 2003, for all other purposes.”.
Amend the title of the bill to read as follows:
“AN ACT relating to public welfare; requiring the Department of Human Resources to develop a list of preferred prescription drugs to be used for the Medicaid program; requiring the Department to manage the use by the Medicaid program of step therapy and prior authorization for prescription drugs; creating the Pharmacy and Therapeutics Committee within the Department; and providing other matters properly relating thereto.”.
Amend the summary of the bill to read as follows:
“SUMMARY―Makes various changes concerning provision of prescription drugs pursuant to Medicaid program. (BDR 38‑775)”.
Assemblywoman Koivisto moved that the Assembly concur in the Senate amendment to Assembly Bill No. 384.
Remarks by Assemblywoman Koivisto.
Motion carried by a constitutional majority.
Bill ordered to enrollment.
Assembly Bill No. 402.
The following Senate amendment was read:
Amendment No. 565.
Amend the bill as a whole by renumbering sections 1 and 2 as sections 2 and 3 and adding a new section designated section 1, following the enacting clause, to read as follows:
“Section 1. Chapter 439A of NRS is hereby amended by adding thereto a new section to read as follows:
1. No person may operate or undertake any proposed expenditure for the operation of a new medical helicopter that will provide medical helicopter services in an area located within 150 miles from the base of an existing medical helicopter without first applying for and obtaining the written approval of the State Health Officer or the designee of the State Health Officer.
2. Except as otherwise provided in subsection 3, the State Health Officer or the designee of the State Health Officer may approve an application submitted pursuant to subsection 1 only if the applicant demonstrates that:
(a) Based on the needs of the specific population to be served by the new medical helicopter and on the projected number of persons who have or will have a need for the proposed service, the population to be served has a need for the new medical helicopter;
(b) The existing medical helicopter services in the area to be served by the new medical helicopter cannot or will not meet the projected needs of the population to be served by the new medical helicopter;
(c) The applicant has the financial stability to provide medical helicopter services to the population to be served by the new medical helicopter for a significant period of time;
(d) The new medical helicopter will result in a significant savings in costs for users of and payors for medical helicopter services;
(e) The new medical helicopter will not have an adverse effect on the quality of care provided to users of medical helicopter services and will not have an unnecessarily negative effect on the cost of medical helicopter services for users of or payors for such services; and
(f) The approval of the application will not adversely affect an existing provider of medical helicopter services.
3. The State Health Officer or the designee of the State Health Officer shall not approve an application submitted pursuant to subsection 1 if:
(a) The applicant fails to provide sufficient, relevant, demonstrative evidence for the approval of the application; or
(b) The evidence opposing the application outweighs the evidence supporting the application.
4. In determining whether to approve an application submitted pursuant to subsection 1, the State Health Officer or the designee of the State Health Officer shall:
(a) Contact existing providers of medical helicopter services, ensure that existing providers of medical helicopter services have an opportunity to participate in any public hearing concerning the application, and seek the input of existing providers of medical helicopter services concerning the application; and
(b) Consider:
(1) The level of medical care to be provided by the applicant to the population to be served by the new medical helicopter;
(2) The impact of the new medical helicopter on the rates, quality of service and safety of existing providers of medical helicopter services and on the level of medical care provided by such providers;
(3) The effect of the new medical helicopter on the cost of health care services; and
(4) Any other information the State Health Officer or the designee of the State Health Officer deems relevant.
5. An applicant whose application is rejected pursuant to this section may appeal the decision of the State Health Officer or the designee of the State Health Officer to the State Board of Health. The decision of the State Board of Health is a final decision for the purposes of judicial review.
6. As used in this section, “medical helicopter” means a helicopter especially designed, constructed, modified or equipped to be used for the transportation of injured or sick persons. The term does not include any commercial helicopter carrying passengers on regularly scheduled flights.”.
Amend sec. 2, page 3, line 5, by deleting “1.”.
Amend sec. 2, page 3, line 10, after “of” by inserting “section 2 of”.
Amend sec. 2, page 3, by deleting lines 11 through 15.
Amend the bill as a whole by renumbering sec. 3 as sec. 5 and adding a new section designated sec. 4, following sec. 2, to read as follows:
“Sec. 4. The provisions of section 1 of this act apply retroactively to each medical helicopter that did not provide medical helicopter services on or before December 31, 2002.”.
Amend sec. 3, page 3, line 16, by deleting: “This act becomes” and inserting:
“1. This section and sections 1 and 4 of this act become effective upon passage and approval.
2. Sections 2 and 3 of this act become”.
Amend the title of the bill, first line, after “care;” by inserting: “requiring a person to obtain the approval of the State Health Officer before operating a new medical helicopter under certain circumstances;”.
Amend the summary of the bill to read as follows:
“SUMMARY―Makes various changes concerning approval of certain medical helicopters and certain health facilities. (BDR 40‑816)”.
Assemblywoman Koivisto moved that the Assembly concur in the Senate amendment to Assembly Bill No. 402.
Remarks by Assemblywoman Koivisto.
Motion carried by a constitutional majority.
Bill ordered to enrollment.
Mr. Speaker announced if there were no objections, the Assembly would recess subject to the call of the Chair.
Assembly in recess at 11:21 a.m.
ASSEMBLY IN SESSION
At 11:25 a.m.
Mr. Speaker presiding.
Quorum present.
Assemblywoman Buckley moved that the Assembly recess until 2:00 p.m.
Motion carried.
Assembly in recess at 11:28 a.m.
ASSEMBLY IN SESSION
At 2:39 p.m.
Mr. Speaker presiding.
Quorum present.
MOTIONS, RESOLUTIONS AND NOTICES
Assemblyman Brown moved that Assembly Bill No. 534 be taken from the Chief Clerk's desk and placed at the top of the General File.
Remarks by Assemblyman Brown.
Motion carried.
Assemblyman Brown moved that Senate Bill No. 491 be taken from its position on the General File and placed at the top of the General File.
Remarks by Assemblyman Brown.
Motion carried.
general file and third reading
Senate Bill No. 491.
Bill read third time.
The following amendment was proposed by Assemblyman Brown:
Amendment No. 890.
Amend section 1, page 2, by deleting lines 18 through 21 and inserting:
“(b) Indicates the subcontractor does not meet the criteria established by regulation”.
Assemblyman Brown moved the adoption of the amendment.
Remarks by Assemblyman Brown.
Amendment adopted.
Bill ordered reprinted, re-engrossed, and to third reading.
Assembly Bill No. 534.
Bill read third time.
The following amendment was proposed by Assemblyman Brown:
Amendment No. 891.
Amend sec. 4, page 2, line 10, by deleting “gross”.
Amend sec. 4, page 2, line 11, by deleting “193.140.” and inserting “193.150.”.
Amend sec. 4, page 2, line 17, by deleting “$10,000” and inserting “$1,000”.
Assemblyman Brown moved the adoption of the amendment.
Remarks by Assemblyman Brown.
Amendment adopted.
Bill ordered reprinted, re-engrossed, and to third reading.
MOTIONS, RESOLUTIONS AND NOTICES
Assemblyman Oceguera moved that Senate Bill No. 351 be taken from its position on the General File and placed at the bottom of the General File.
Motion carried.
general file and third reading
Senate Bill No. 354.
Bill read third time.
Remarks by Assemblyman Collins.
Potential conflict of interest declared by Assemblyman Collins.
Roll call on Senate Bill No. 354:
Yeas—42.
Nays—None.
Senate Bill No. 354 having received a constitutional majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 372.
Bill read third time.
Roll call on Senate Bill No. 372:
Yeas—41.
Nays—Collins.
Senate Bill No. 372 having received a constitutional majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 386.
Bill read third time.
Roll call on Senate Bill No. 386:
Yeas—42.
Nays—None.
Senate Bill No. 386 having received a constitutional majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 413.
Bill read third time.
Roll call on Senate Bill No. 413:
Yeas—42.
Nays—None.
Senate Bill No. 413 having received a constitutional majority, Mr. Speaker declared it passed.
Bill ordered transmitted to the Senate.
Senate Bill No. 423.
Bill read third time.
Roll call on Senate Bill No. 423:
Yeas—42.
Nays—None.
Senate Bill No. 423 having received a constitutional majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
MOTIONS, RESOLUTIONS AND NOTICES
Assemblyman Oceguera moved that Senate Bill No. 174 be taken from the Chief Clerk’s desk and placed on the General File.
Motion carried.
Assemblyman Oceguera moved that Senate Bill No. 460 be taken from the Chief Clerk’s desk and placed on the General File.
Motion carried.
general file and third reading
Senate Bill No. 426.
Bill read third time.
Roll call on Senate Bill No. 426:
Yeas—41.
Nays—None.
Not Voting—Goldwater.
Senate Bill No. 426 having received a two-thirds majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 436.
Bill read third time.
Roll call on Senate Bill No. 436:
Yeas—42.
Nays—None.
Senate Bill No. 436 having received a two-thirds majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 444.
Bill read third time.
Remarks by Assemblyman Christensen.
Roll call on Senate Bill No. 444:
Yeas—40.
Nays—Claborn, Parks—2.
Senate Bill No. 444 having received a constitutional majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 449.
Bill read third time.
Roll call on Senate Bill No. 449:
Yeas—42.
Nays—None.
Senate Bill No. 449 having received a constitutional majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 451.
Bill read third time.
Roll call on Senate Bill No. 451:
Yeas—40.
Nays—Angle, Gustavson—2.
Senate Bill No. 451 having received a two-thirds majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
MOTIONS, RESOLUTIONS AND NOTICES
Assemblyman Oceguera moved that Senate Bill No. 168 just returned from the printer, be placed at the top of the General File.
Motion carried.
general file and third reading
Senate Bill No. 168.
Bill read third time.
Roll call on Senate Bill No. 168:
Yeas—42.
Nays—None.
Senate Bill No. 168 having received a constitutional majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 452.
Bill read third time.
Roll call on Senate Bill No. 452:
Yeas—42.
Nays—None.
Senate Bill No. 452 having received a constitutional majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 453.
Bill read third time.
Roll call on Senate Bill No. 453:
Yeas—42.
Nays—None.
Senate Bill No. 453 having received a constitutional majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 459.
Bill read third time.
Roll call on Senate Bill No. 459:
Yeas—42.
Nays—None.
Senate Bill No. 459 having received a constitutional majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 470.
Bill read third time.
Roll call on Senate Bill No. 470:
Yeas—42.
Nays—None.
Senate Bill No. 470 having received a constitutional majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
MOTIONS, RESOLUTIONS AND NOTICES
Assemblywoman Giunchigliani moved that Senate Bill No. 425 be taken from the Chief Clerk’s desk and placed at the top of the General File.
Remarks by Assemblywoman Giunchigliani.
Motion carried.
general file and third reading
Senate Bill No. 425.
Bill read third time.
The following amendment was proposed by Assemblywoman Giunchigliani:
Amendment No. 899.
Amend section 1, page 2, line 2, by deleting: “2 to 3.7, inclusive,” and inserting: “2, 3 and 3.5”.
Amend sec. 3.5, page 2, by deleting line 25 and inserting “Board;”.
Amend the bill as a whole by deleting sec. 3.7.
Amend the title of the bill, first through third lines, by deleting: “prohibiting a pharmacist from refusing to fill or refill a prescription under certain circumstances;”.
Assemblywoman Giunchigliani moved the adoption of the amendment.
Remarks by Assemblywoman Giunchigliani.
Amendment adopted.
Bill ordered reprinted, re-engrossed, and to third reading.
Senate Bill No. 475.
Bill read third time.
Roll call on Senate Bill No. 475:
Yeas—42.
Nays—None.
Senate Bill No. 475 having received a constitutional majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 476.
Bill read third time.
Remarks by Assemblywoman Chowning.
Roll call on Senate Bill No. 476:
Yeas—41.
Nays—Angle.
Senate Bill No. 476 having received a constitutional majority, Mr. Speaker declared it passed.
Bill ordered transmitted to the Senate.
Senate Bill No. 478.
Bill read third time.
Roll call on Senate Bill No. 478:
Yeas—42.
Nays—None.
Senate Bill No. 478 having received a constitutional majority, Mr. Speaker declared it passed.
Bill ordered transmitted to the Senate.
Mr. Speaker announced if there were no objections, the Assembly would recess subject to the call of the Chair.
Assembly in recess at 3:09 p.m.
ASSEMBLY IN SESSION
At 3:15 p.m.
Mr. Speaker presiding.
Quorum present.
Senate Bill No. 481.
Bill read third time.
Remarks by Assemblyman Gustavson.
Roll call on Senate Bill No. 481:
Yeas—42.
Nays—None.
Senate Bill No. 481 having received a constitutional majority, Mr. Speaker declared it passed.
Bill ordered transmitted to the Senate.
Senate Bill No. 482.
Bill read third time.
Roll call on Senate Bill No. 482:
Yeas—42.
Nays—None.
Senate Bill No. 482 having received a constitutional majority, Mr. Speaker declared it passed.
Bill ordered transmitted to the Senate.
Senate Bill No. 485.
Bill read third time.
Roll call on Senate Bill No. 485:
Yeas—39.
Nays—Angle, Carpenter, Gustavson—3.
Senate Bill No. 485 having received a two-thirds majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 486.
Bill read third time.
Roll call on Senate Bill No. 486:
Yeas—42.
Nays—None.
Senate Bill No. 486 having received a two-thirds majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 489.
Bill read third time.
Remarks by Assemblymen Goldwater and Parks.
Roll call on Senate Bill No. 489:
Yeas—22.
Nays—Anderson, Andonov, Atkinson, Brown, Buckley, Carpenter, Christensen, Claborn, Conklin, Giunchigliani, Goldwater, Horne, Knecht, Koivisto, Leslie, Manendo, Oceguera, Ohrenschall, Perkins, Williams—20.
Senate Bill No. 489 having received a constitutional majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 490.
Bill read third time.
Roll call on Senate Bill No. 490:
Yeas—42.
Nays—None.
Senate Bill No. 490 having received a constitutional majority, Mr. Speaker declared it passed.
Bill ordered transmitted to the Senate.
Senate Bill No. 493.
Bill read third time.
Roll call on Senate Bill No. 493:
Yeas—42.
Nays—None.
Senate Bill No. 493 having received a constitutional majority, Mr. Speaker declared it passed.
Bill ordered transmitted to the Senate.
MOTIONS, RESOLUTIONS AND NOTICES
Assemblywoman Chowning moved that Senate Bill No. 356 be taken from the Chief Clerk’s desk and placed at the top of the General File.
Remarks by Assemblywoman Chowning.
Motion carried.
general file and third reading
Senate Bill No. 356.
Bill read third time.
The following amendment was proposed by Assemblywoman Chowning:
Amendment No. 892.
Amend section 1, pages 1 and 2, by deleting lines 14 through 17 on page 1 and lines 1 through 9 on page 2, and inserting:
“3. A person who violates this section:
(a) If no property damage and no bodily injury or death results from the violation, shall, except as otherwise provided in subsection 4, be punished by a fine not to exceed $100.
(b) If property damage results from the violation but no bodily injury or death results from the violation, is guilty of a public offense proportionate to the value of the property damaged or destroyed as set forth in NRS 193.155.
(c) If bodily injury not including death results from the violation, is guilty of a gross misdemeanor and shall be punished as provided in NRS 193.140.
(d) If death results from the violation, is guilty of a category D felony and shall be punished as provided in NRS 193.130.
4. With respect only to a violation of this section that results in no property damage, no bodily injury and no death, as described in paragraph (a) of subsection 3, a person who commits such a violation shall not be punished for the violation unless the person committed the violation while driving, moving or operating a commercial motor vehicle.
5. As used in this section, “commercial motor vehicle” means a motor vehicle used primarily for the transportation of goods, materials or property in furtherance of commercial enterprise.”.
Amend the title of the bill by deleting the third and fourth lines and inserting: “and providing other matters”.
Assemblywoman Chowning moved the adoption of the amendment.
Remarks by Assemblymen Chowning, Carpenter, Brown, Buckley, Collins, and Knecht.
Mr. Speaker requested the privilege of the Chair for the purpose of making remarks.
MOTIONS, RESOLUTIONS AND NOTICES
Assemblywoman Chowning moved that Senate Bill No. 356 be taken from the General File and placed on the Chief Clerk's desk.
Remarks by Assemblywoman Chowning.
Motion carried.
Mr. Speaker announced if there were no objections, the Assembly would recess subject to the call of the Chair.
Assembly in recess at 3:38 p.m.
ASSEMBLY IN SESSION
At 3:43 p.m.
Mr. Speaker presiding.
Quorum present.
Mr. Speaker announced if there were no objections, the Assembly would recess subject to the call of the Chair.
Assembly in recess at 3:44 p.m.
ASSEMBLY IN SESSION
At 7:00 p.m.
Mr. Speaker presiding.
Quorum present.
REPORTS OF COMMITTEES
Mr. Speaker:
Your Committee on Judiciary, to which was referred Senate Bill No. 97, has had the same under consideration, and begs leave to report the same back with the recommendation: Amend, and do pass as amended.
Bernie Anderson, Chairman
MOTIONS, RESOLUTIONS AND NOTICES
Assemblyman Oceguera moved that all rules be suspended and that Senate Bill No. 97 just reported out of committee be declared an emergency measure under the Constitution and placed at the top of the General File.
Motion carried unanimously.
Assemblyman Oceguera moved that Assembly Bill No. 534 and Senate Bills Nos. 425 and 491 just returned from the printer, be placed on the General File.
Motion carried.
Assemblyman Oceguera moved that all rules be suspended and that Senate Bill No. 319 be declared an emergency measure under the Constitution and placed at the top of the General File.
Motion carried unanimously.
Assemblyman Goldwater moved that Senate Bill No. 370 be taken from the Chief Clerk’s desk and placed at the top of the General File.
Motion carried.
Notice of Waiver
A Waiver requested by Speaker Perkins
For: Assembly Bill No. 417.
To Waive:
Subsections 1 and 2 of Joint Standing Rule No. 14 and Joint Standing Rule Nos. 14.2 and 14.3 (all of the above)
Has been granted effective: May 23, 2003.
|
William J. Raggio |
Richard D. Perkins |
|
Senate Majority Leader |
Speaker of the Assembly |
A Waiver requested by Senator Raggio and Speaker Perkins
For: Senate Bill No. 66.
To Waive:
Subsections 1 and 2 of Joint Standing Rule No. 14 and Joint Standing Rule Nos. 14.2 and 14.3 (all of the above)
Has been granted effective: May 23, 2003.
|
William J. Raggio |
Richard D. Perkins |
|
Senate Majority Leader |
Speaker of the Assembly |
A Waiver requested by Senator Raggio and Speaker Perkins
For: Senate Bill No. 355.
To Waive:
Subsections 1 and 2 of Joint Standing Rule No. 14 and Joint Standing Rule Nos. 14.2 and 14.3 (all of the above)
Has been granted effective: May 23, 2003.
|
William J. Raggio |
Richard D. Perkins |
|
Senate Majority Leader |
Speaker of the Assembly |
A Waiver requested by Senator Raggio and Speaker Perkins
For: Senate Bill No. 471.
To Waive:
Subsections 1 and 2 of Joint Standing Rule No. 14 and Joint Standing Rule Nos. 14.2 and 14.3 (all of the above)
Has been granted effective: May 23, 2003.
|
William J. Raggio |
Richard D. Perkins |
|
Senate Majority Leader |
Speaker of the Assembly |
Mr. Speaker announced if there were no objections, the Assembly would recess subject to the call of the Chair.
Assembly in recess at 7:05 p.m.
ASSEMBLY IN SESSION
At 7:07 p.m.
Mr. Speaker presiding.
Quorum present.
general file and third reading
Senate Bill No. 370.
Bill read third time.
The following amendment was proposed by Assemblyman Goldwater:
Amendment No. 901.
Amend the bill as a whole by renumbering sections 1 through 16 as sections 3 through 18 and adding new sections designated sections 1 and 2, following the enacting clause, to read as follows:
“Section 1. Chapter 360 of NRS is hereby amended by adding thereto a new section to read as follows:
1. The Department shall account separately for all money received pursuant to subsection 3 of NRS 482.181 and shall administer that account pursuant to the provisions of this section. If the balance in the account that has not been committed for expenditure exceeds $300,000 at the end of any fiscal year, the uncommitted amount that exceeds the threshold must be reverted to the counties of origin on a pro rata basis.
2. A county whose population is less than 100,000 in which a tax has been imposed pursuant to section 3 of this act at the maximum amount allowed by law may apply to the Department for a distribution from the account. The total of all distributions in any fiscal year to one county must not exceed the sum obtained by subtracting the amount of the proceeds of the tax imposed pursuant to section 3 of this act for that fiscal year from the amount received by the county from the proceeds of the basic governmental services tax for the fiscal year ending on June 30, 2003.
3. In administering the account, the Department shall adopt by regulation a procedure for making the distributions required by subsection 2. The procedure must ensure that for any fiscal year in which the balance in the account is not sufficient to make distributions to all counties for the maximum amount allowed by law, each county receives a distribution, if requested, of a percentage of the total amount requested by that county that is equal to the percentage of the money requested by all other counties to which distributions are made.
Sec. 2. NRS 371.040 is hereby amended to read as follows:
371.040 The annual amount of the basic governmental
services tax throughout the State is [4] 3 cents on each $1 of
valuation of the vehicle as determined by the Department.”.
Amend section 1, page 1, by deleting lines 4 through 6 and inserting: “property, the board of county commissioners of each county may impose a tax at the rate of up to $1.20 for each $500 of value, or fraction thereof, on each deed”.
Amend section 1, page 2, by deleting lines 5 through 8 and inserting: “provided in NRS 375.030.”.
Amend sec. 3, page 2, lines 33, 38 and 40, by deleting “1” and inserting “3”.
Amend sec. 5, page 4, line 14, by deleting “1” and inserting “3”.
Amend sec. 15, page 10, line 9, by deleting “1” and inserting “3”.
Amend sec. 16, page 10, line 31, by deleting “1” and inserting “3”.
Amend the bill as a whole by deleting sec. 17,
renumbering sec. 18 as
sec. 20 and adding a new section designated sec. 19, following sec. 16, to read
as follows:
“Sec. 19. NRS 482.181 is hereby amended to read as follows:
482.181 1. Except as otherwise provided in subsection [5,]
6, after deducting the amount withheld by the Department and the amount
credited to the Department pursuant to subsection 6 of NRS 482.180, the
Department shall certify monthly to the State Board of Examiners the amount of
the basic and supplemental governmental services taxes collected for each
county by the Department and its agents during the preceding month, and that
money must be distributed monthly as provided in this section.
2. Any supplemental governmental services tax collected
for a county must be distributed only to the county, to be used as provided in
NRS 371.045 and 371.047.
3. [The] Before making any distribution of
the basic governmental services tax pursuant to subsections 4 and 5, 10 percent
of the amount of that tax received or collected for each county must be
deposited into a separate account in the State General Fund for distribution by
the Department of Taxation as provided in section 1 of this act.
4. After making the distribution set forth in
subsection 3, the distribution of the basic governmental services tax
received or collected for each county must be made to the county school
district within each county before any distribution is made to a local government,
special district or enterprise district. For the purpose of calculating the
amount of the basic governmental services tax to be distributed to the county
school district, the taxes levied by each local government, special district
and enterprise district are the product of its certified valuation, determined
pursuant to subsection 2 of
NRS 361.405, and its tax rate, established pursuant to NRS 361.455 for the
fiscal year beginning on July 1, 1980, except that the tax rate for school
districts, including the rate attributable to a district’s debt service, is the
rate established pursuant to NRS 361.455 for the fiscal year beginning on July
1, 1978, but if, in any fiscal year, the sum of the rate attributable to a
district’s debt service in that fiscal year and any rate levied for capital
projects pursuant to NRS 387.3285 in that fiscal year is greater than its rate
for the fiscal year beginning on July 1, 1978, the higher rate must be used to
determine the amount attributable to debt service.
[4.] 5. After making the distributions
set forth in [subsection 3,] subsections 3 and 4, the remaining
money received or collected for each county must be deposited in the Local
Government Tax Distribution Account created by NRS 360.660 for distribution to
local governments, special districts and enterprise districts within each
county pursuant to the provisions of NRS 360.680 and 360.690.
[5.] 6. An amount equal to any basic
governmental services tax distributed to a redevelopment agency in the fiscal
year 1987-1988 must continue to be distributed to that agency as long as it
exists but must not be increased.
[6.] 7. The Department shall make
distributions of the basic governmental services tax directly to county school
districts.
[7.] 8. As used in this section:
(a) “Enterprise district” has the meaning ascribed to it in NRS 360.620.
(b) “Local government” has the meaning ascribed to it in NRS 360.640.
(c) “Received or collected for each county” means:
(1) For the basic governmental services tax collected on vehicles subject to the provisions of chapter 706 of NRS, the amount determined for each county based on the following percentages:
Carson City 1.07 percent Lincoln 3.12 percent
Churchill 5.21 percent Lyon 2.90 percent
Clark 22.54 percent Mineral 2.40 percent
Douglas 2.52 percent Nye 4.09 percent
Elko 13.31 percent Pershing 7.00 percent
Esmeralda 2.52 percent Storey .19 percent
Eureka 3.10 percent Washoe 12.24 percent
Humboldt 8.25 percent White Pine 5.66 percent
Lander 3.88 percent
(2) For all other basic and supplemental governmental services tax received or collected by the Department, the amount attributable to each county based on the county of registration of the vehicle for which the tax was paid.
(d) “Special district” has the meaning ascribed to it in NRS 360.650.”.
Amend sec. 18, page 12, by deleting line 13 and inserting:
“Sec. 20. This act becomes effective on January 1, 2004.”.
Amend the title of the bill to read as follows:
“AN ACT relating to taxation; reducing the rate of the basic governmental services tax; authorizing each board of county commissioners to impose an additional tax on the transfer of real property; authorizing the distribution of a portion of the proceeds of the basic governmental services tax to reimburse certain counties for a reduction in revenue; and providing other matters properly relating thereto.”.
Amend the summary of the bill to read as follows:
“SUMMARY—Reduces rate of basic governmental services tax and authorizes counties to impose additional tax on transfer of real property. (BDR 32‑39)”.
Assemblyman Goldwater moved the adoption of the amendment.
Remarks by Assemblymen Goldwater, Hettrick, and Goicoechea.
Amendment adopted.
Bill ordered reprinted, re-engrossed, and to third reading.
Senate Bill No. 97.
Bill read third time.
The following amendment was proposed by the Committee on Judiciary:
Amendment No. 774.
Amend the bill as a whole by deleting sections 1 through 12 and the text of repealed sections and adding new sections designated sections 1 through 47 and the text of the repealed section, following the enacting clause, to read as follows:
“Section 1. This act may be cited as the “Keep Quality Medical Care in Nevada Act.”
Sec. 1.5. The Legislature hereby finds and declares that:
1. The 18th Special Session of the Nevada Legislature was held in 2002 to address the State’s emerging medical malpractice crisis.
2. The Nevada Legislature recognized that the difficulty experienced in this state in attracting and maintaining a sufficient network of physicians to meet the needs of the residents of this state posed a serious threat to the health, welfare and safety of those residents.
3. The Nevada Legislature unanimously approved broad tort reforms during the 18th Special Session to provide stability and predictability to Nevada’s civil justice system and insurance market while protecting the legal remedies available to injured patients.
4. The reforms passed by the Nevada Legislature during the 18th Special Session included:
(a) A $350,000 limitation on the amount that may be awarded for noneconomic damages in a medical malpractice action, which was carefully crafted to limit a physician’s liability and provide compensation to an injured patient;
(b) A $50,000 limitation on the amount of damages that may be awarded in a medical malpractice action for emergency care received in hospitals;
(c) Immunity from liability for certain providers of health care who provide treatment gratuitously at a health care facility of a governmental entity or nonprofit organization;
(d) Protection of the right to consider collateral sources of payment to a patient and to elect to receive future damages awarded in periodic payments;
(e) Several liability for noneconomic damages awarded in an action for medical malpractice so that a physician is only liable for such damages in an amount equal to the percentage of negligence attributable to him;
(f) Increasing the efficiency of the civil justice system by providing a shorter period within which to commence a medical malpractice action, making changes concerning pretrial settlement conferences and requiring certain district judges to receive certain training concerning medical malpractice actions;
(g) Stricter requirements concerning reporting information concerning medical malpractice to state licensing boards; and
(h) Requiring the reporting of medical errors and protecting “whistle blowers” who report medical errors or potential medical malpractice.
5. The Nevada Legislature responded to the crisis in 2002 and proposes the additional protections to consumers of medical care in this state as set forth in this act.
Sec. 2. Chapter 630 of NRS is hereby amended by adding thereto a new section to read as follows:
1. If, within the immediately preceding 7 years, a
physician has made three reports or has had three reports made concerning him
pursuant to
NRS 630.3067, a committee designated by the Board and consisting of members of
the Board shall review the reports and conduct an investigation to determine
whether it is necessary or appropriate to initiate disciplinary action pursuant
to this chapter against the physician.
2. If, after conducting the investigation, the committee determines that it is necessary or appropriate to initiate disciplinary action pursuant to this chapter against the physician, the committee shall file a formal complaint with the Board.
Sec. 3. NRS 630.3067 is hereby amended to read as follows:
630.3067 1. The
insurer of a physician licensed under this chapter and the physician [must]
shall report to the Board [any action filed or claim] :
(a) Any action for malpractice filed against the
physician not later than
45 days after the physician receives service of a summons and complaint for the
action;
(b) Any claim for malpractice against the physician
that is submitted to arbitration or mediation [for malpractice or
negligence against the physician and the] not later than 45 days after
the claim is submitted to arbitration or mediation; and
(c) Any settlement, award, judgment or other
disposition of [the] any action or claim [within 30 days
after:
(a) The
action was filed or the claim was submitted to arbitration or mediation; and
(b) The
disposition of the action or claim.] described in paragraph (a) or (b)
not later than 45 days after the settlement, award, judgment or other
disposition.
2. The Board shall report any failure to comply with subsection 1 by an insurer licensed in this state to the Division of Insurance of the Department of Business and Industry. If, after a hearing, the Division of Insurance determines that any such insurer failed to comply with the requirements of subsection 1, the Division may impose an administrative fine of not more than $10,000 against the insurer for each such failure to report. If the administrative fine is not paid when due, the fine must be recovered in a civil action brought by the Attorney General on behalf of the Division.
Sec. 4. NRS 630.339 is hereby amended to read as follows:
630.339 1. If a committee designated by the Board to conduct an investigation of a complaint or conduct an investigation pursuant to section 2 of this act decides to proceed with disciplinary action, it shall bring charges against the licensee. If charges are brought, the Board shall fix a time and place for a formal hearing. If the Board receives a report pursuant to subsection 5 of NRS 228.420, such a hearing must be held within 30 days after receiving the report. The Board shall notify the licensee of the charges brought against him, the time and place set for the hearing, and the possible sanctions authorized in NRS 630.352.
2. The Board, a hearing officer or a panel of its members designated by the Board shall hold the formal hearing on the charges at the time and place designated in the notification. If the hearing is before a panel, at least one member of the Board who is not a physician must participate in this hearing.
Sec. 5. NRS 630.352 is hereby amended to read as follows:
630.352 1. Any member of the Board, except for an advisory member serving on a panel of the Board hearing charges, may participate in the final order of the Board. If the Board, after a formal hearing, determines from a preponderance of the evidence that a violation of the provisions of this chapter or of the regulations of the Board has occurred, it shall issue and serve on the physician charged an order, in writing, containing its findings and any sanctions.
2. If the Board determines that no violation has occurred, it shall dismiss the charges, in writing, and notify the physician that the charges have been dismissed. If the disciplinary proceedings were instituted against the physician as a result of a complaint filed against him, the Board may provide the physician with a copy of the complaint.
3. Except as otherwise provided in [subsection 4,]
subsections 4 and 5, if the Board finds that a violation has occurred,
it may by order:
(a) Place the person on probation for a specified period on any of the conditions specified in the order;
(b) Administer to him a public reprimand;
(c) Limit his practice or exclude one or more specified branches of medicine from his practice;
(d) Suspend his license for a specified period or until further order of the Board;
(e) Revoke his license to practice medicine;
(f) Require him to participate in a program to correct alcohol or drug dependence or any other impairment;
(g) Require supervision of his practice;
(h) Impose a fine not to exceed $5,000;
(i) Require him to perform community service without compensation;
(j) Require him to take a physical or mental examination or an examination testing his competence;
(k) Require him to fulfill certain training or educational requirements; and
(l) Require him to pay all costs incurred by the Board relating to his disciplinary proceedings.
4. If the Board finds that the physician has violated the provisions of NRS 439B.425, the Board shall suspend his license for a specified period or until further order of the Board.
5. If the Board finds that the physician is not competent to practice medicine, the Board shall revoke his license.
Sec. 6. NRS 630.356 is hereby amended to read as follows:
630.356 1. Any person aggrieved by a final order of the Board is entitled to judicial review of the Board’s order.
2. Every order that imposes a sanction against a
licensee pursuant to subsection 3 , [or] 4 or 5 of NRS
630.352 or any regulation of the Board is effective from the date the
Secretary-Treasurer certifies the order until the date the order is modified or
reversed by a final judgment of the court. The court shall not stay the order
of the Board pending a final determination by the court.
3. The district court shall give a petition for judicial review of the Board’s order priority over other civil matters which are not expressly given priority by law.
Sec. 7. Chapter 633 of NRS is hereby amended by adding thereto a new section to read as follows:
1. If, within the immediately preceding 7 years, an osteopathic physician has made three reports or has had three reports made concerning him pursuant to NRS 633.526, the Board shall designate a member of the Board to review the reports and conduct an investigation to determine whether it is necessary or appropriate to initiate disciplinary action pursuant to this chapter against the osteopathic physician.
2. If, after conducting the investigation, the member determines that it is necessary or appropriate to initiate disciplinary action pursuant to this chapter against the osteopathic physician, the member shall file a formal complaint with the Board.
Sec. 8. NRS 633.526 is hereby amended to read as follows:
633.526 1. The
insurer of an osteopathic physician licensed under this chapter and the
osteopathic physician [must] shall report to the Board [any
action filed or claim] :
(a) Any action for malpractice filed against the osteopathic physician not later than 45 days after the osteopathic physician receives service of a summons and complaint for the action;
(b) Any claim for malpractice against the osteopathic
physician that is submitted to arbitration or mediation [for malpractice
or negligence against the osteopathic physician and the] not later than
45 days after the claim is submitted to arbitration or mediation; and
(c) Any settlement, award, judgment or other
disposition of [the] any action or claim [within 30 days
after:
(a) The
action was filed or the claim was submitted to arbitration or mediation; and
(b) The
disposition of the action or claim.] described in paragraph (a) or (b)
not later than 45 days after the settlement, award, judgment or other
disposition.
2. The Board shall report any failure to comply with subsection 1 by an insurer licensed in this state to the Division of Insurance of the Department of Business and Industry. If, after a hearing, the Division of Insurance determines that any such insurer failed to comply with the requirements of subsection 1, the Division may impose an administrative fine of not more than $10,000 against the insurer for each such failure to report. If the administrative fine is not paid when due, the fine must be recovered in a civil action brought by the Attorney General on behalf of the Division.
Sec. 9. NRS 633.621 is hereby amended to read as follows:
633.621 If a formal complaint is filed with the Board
pursuant to
NRS 633.541 [,] or section 7 of this act, the Secretary of the
Board shall fix a time and place for a hearing and cause a notice of the
hearing and a formal complaint to be served on the person charged at least 20
days before the date fixed for the hearing. If the Board receives a formal
complaint concerning subsection 5 of NRS 228.420, such a hearing must be held
within 30 days after receiving the formal complaint.
Sec. 10. NRS 633.651 is hereby amended to read as follows:
633.651 1. The person charged in a formal complaint is entitled to a hearing before the Board, but the failure of the person charged to attend his hearing or his failure to defend himself must not delay or void the proceedings. The Board may, for good cause shown, continue any hearing from time to time.
2. [If] Except as otherwise provided in
subsection 3, if the Board finds the person guilty as charged in the formal
complaint, it may by order:
(a) Place the person on probation for a specified period or until further order of the Board.
(b) Administer to the person a public reprimand.
(c) Limit the practice of the person to, or by the exclusion of, one or more specified branches of osteopathic medicine.
(d) Suspend the license of the person to practice osteopathic medicine for a specified period or until further order of the Board.
(e) Revoke the license of the person to practice osteopathic medicine.
The order of the Board may contain such other terms, provisions or conditions as the Board deems proper and which are not inconsistent with law.
3. If the Board finds that the osteopathic physician is not competent to practice osteopathic medicine, the Board shall revoke his license.
Sec. 11. Chapter 41A of NRS is hereby amended by adding thereto the provisions set forth as sections 12 to 33, inclusive, of this act.
Sec. 12. As used in sections 12 to 32, inclusive, of this act, unless the context otherwise requires, the words and terms defined in sections 13, 14 and 15 of this act have the meanings ascribed to them in those sections.
Sec. 13. “Dentist” means a person licensed to practice dentistry or any special branch of dentistry pursuant to chapter 631 of NRS.
Sec. 14. “Division” means the Division of Insurance of the Department of Business and Industry.
Sec. 15. “Health care records” means any written reports, notes, orders, photographs, X-rays or other written record received or produced by a provider of health care, or any person employed by him, which contains information relating to the medical or dental history, examination, diagnosis or treatment of the patient.
Sec. 16. 1. No cause of action involving medical malpractice or dental malpractice may be filed until the medical malpractice or dental malpractice case has been submitted to an appropriate screening panel and a determination has been made by such a panel as provided in sections 12 to 32, inclusive, of this act, and any action filed without satisfying the requirements of those sections is subject to dismissal without prejudice for failure to comply with this section.
2. Except as otherwise provided in subsection 3, the written findings of the screening panel are admissible in any action concerning that claim which is subsequently filed in district court. No other evidence concerning the screening panel or its deliberations is admissible, and no member of the screening panel may be called to testify in any such action.
3. If the screening panel finds that it is unable to reach a decision on the issue of medical malpractice or dental malpractice, the written findings of the screening panel are not admissible in any action concerning that claim which is subsequently filed in district court.
Sec. 17. There are hereby created two tentative screening panels, one to be known as the Northern Panel, from which must be selected screening panels to sit in Reno, Nevada, to hear claims of medical malpractice or dental malpractice arising in the counties of Washoe, Storey, Douglas, Lyon, Churchill, Pershing, Humboldt, Lander, Elko, Eureka, Mineral, White Pine and Carson City, and one to be known as the Southern Panel, from which must be selected screening panels to sit in Las Vegas, Nevada, to hear claims of medical malpractice or dental malpractice arising in the counties of Lincoln, Nye, Esmeralda and Clark.
Sec. 18. 1. For cases involving medical malpractice or dental malpractice, the Board of Governors of the Nevada Trial Lawyers Association may designate 40 of its members to serve on the Northern Tentative Screening Panel and 60 of its members to serve on the Southern Tentative Screening Panel. Each person so designated shall serve for a term of 1 year.
2. For cases involving medical malpractice, the Executive Council of the Nevada State Medical Association may designate 40 of its members to serve on the Northern Tentative Screening Panel and 60 of its members to serve on the Southern Tentative Screening Panel. Each person so designated shall serve for a term of 1 year.
3. For cases involving medical malpractice, the Nevada Hospital Association may designate 40 administrators of hospitals and other persons employed by hospitals in management positions to serve as nonvoting members of the tentative screening panels. Each person so designated shall serve for a term of 1 year.
4. For cases involving dental malpractice, the Nevada Dental Association may designate 40 of its members to serve on the Northern Tentative Screening Panel and 40 of its members to serve on the Southern Tentative Screening Panel. Each person so designated shall serve for a term of 1 year.
Sec. 19. 1. The Commissioner of Insurance shall arrange for courses of instruction in the rules of procedure and substantive law appropriate for members of a screening panel.
2. Each person designated to serve on a tentative screening panel shall attend the instruction provided pursuant to subsection 1 before serving on a particular screening panel.
Sec. 20. 1. The members of a screening panel shall elect one member to serve as chairman.
2. A screening panel is a state agency. The rules adopted pursuant to section 22 of this act apply to all screening panels.
Sec. 21. The provisions of chapter 241 of NRS do not apply to any meeting of a screening panel.
Sec. 22. The Division, through the Commissioner of Insurance:
1. Shall maintain a list of the names of the attorneys, physicians, dentists, administrators of hospitals and persons employed by hospitals in management positions on the Northern Tentative Screening Panel and on the Southern Tentative Screening Panel;
2. Shall select the members of the screening panels;
3. Shall schedule the hearings for the screening panels;
4. Shall obtain, before or after the filing of a claim, such health care records, statements of policy and procedure and other materials as may be required by a screening panel in connection with the claim;
5. Shall charge and collect a reasonable fee for copying materials produced under subpoena;
6. Shall adopt regulations prescribing the fees to be paid to the Division by any party that is not a governmental entity in an amount sufficient to pay:
(a) All administrative costs incurred to create the tentative screening panels, train the members of the tentative screening panels, appoint members to the screening panels and enable such members to carry out the duties of the screening panels; and
(b) Any other costs reasonably incurred in carrying out the purposes of sections 12 to 32, inclusive, of this act;
7. For good cause shown, may authorize a continuance for the proceedings involving a screening panel; and
8. May adopt such rules of practice and procedure as are necessary to carry out its duties pursuant to sections 12 to 32, inclusive, of this act.
Sec. 23. Any money received by the Division pursuant to the provisions of sections 12 to 32, inclusive, of this act must be deposited with the State Treasurer for credit to the account for the Division of Insurance in the State General Fund. The administrative costs of the screening panels must be paid from the account.
Sec. 24. 1. A matter which allegedly involves medical malpractice or dental malpractice is properly presented to a screening panel by filing a claim with the Division and paying any required fee.
2. The claim must include the following, and no other information:
(a) A clear and concise statement of the facts of the matter, showing the persons involved and the dates and circumstances, so far as they are known, of the alleged medical malpractice or dental malpractice. The claim must not contain any statement of fact that is not included within the health care records of the claimant or any statement about the standard of care that was provided to the claimant.
(b) One or more affidavits from medical or dental experts, as appropriate, providing opinions concerning the appropriate standard of care, the breach of the standard of care, how the breach caused the injury and a description of the injury. A screening panel may dismiss a claim if the claim is filed without such an affidavit.
3. The person against whom a claim is made must, within 90 days after receipt of the claim, file an answer with the Division and pay any required fee. The answer may only include:
(a) A clear and concise statement of the facts of the matter, showing the persons involved and the dates and circumstances, so far as they are known, of the medical or dental care provided. The answer must not contain any statement of fact that is not included within the health care records of the claimant or any statement about the standard of care that was provided to the claimant.
(b) One or more affidavits from medical or dental experts, as appropriate, providing opinions concerning the appropriate standard of care, whether there was a breach of the standard of care, whether the breach of that standard of care caused the injury and a description of the injury.
4. The Division may authorize an extension of the time in which an answer must be filed only if all parties to the matter stipulate to the extension. If an answer is not timely filed with the Division, the respondent who failed to file the answer may not participate in any conference held pursuant to section 25 of this act.
5. The claimant may file a written response to the answer with the Division within 30 days after he receives the answer. The response must not contain any statement of fact that is not included within the health care records of the claimant or any statement about the standard of care provided to the claimant. The screening panel shall disregard any portion of the response that does not address a statement in the answer or an affidavit accompanying the answer. One or more additional affidavits from medical or dental experts may be included with the response providing opinions concerning the appropriate standard of care, whether there was a breach of the standard of care, whether the breach of that standard of care caused the injury and a description of the injury. No fee may be charged or collected by the Division for the filing of the response.
6. The Division may authorize an extension of the time in which a response may be filed only if all parties to the matter stipulate to the extension. Unless otherwise stipulated to by all the parties to the matter, the Division may not accept any response that is not timely filed.
7. A copy of any claim, answer or response filed with the Division pursuant to this section must be delivered by the party, by certified or registered mail or by personal service, to each opposing party or, if he is represented in the proceedings of the screening panel by counsel, to his attorney.
Sec. 25. 1. Within 35 days after the expiration of
the time in which to answer a claim of medical malpractice or dental
malpractice, the Division shall hold a conference to resolve any issues as to
challenges for cause. For good cause shown, the Division may continue the
conference once, for a period not to exceed 7 days. A party may challenge any
person on the tentative screening panel for cause on any of the grounds
provided by
NRS 16.050 for the challenge of jurors.
2. The Division shall determine whether cause exists to excuse any member of the tentative screening panel and shall notify each party of the excused members no later than the completion of the conference required by subsection 1.
3. Except as otherwise provided in this subsection, each party is entitled to not more than:
(a) Two peremptory challenges from the list of attorneys in cases involving medical malpractice or dental malpractice;
(b) Two peremptory challenges from the list of physicians in cases involving medical malpractice; and
(c) Two peremptory challenges from the list of dentists in cases involving dental malpractice.
In any case in which there are two or more claimants or respondents, they are collectively entitled to not more than four peremptory challenges from the list of members selected for the tentative screening panel. Each party asserting a peremptory challenge shall notify the Division of the challenge at the conference required by subsection 1. If several parties are represented by the same attorney, those parties shall be deemed to be one party for the purpose of determining the distribution of peremptory challenges.
4. In cases involving medical malpractice, the Division shall randomly select, from the list of members of the tentative screening panel who have not been excused for cause or by a peremptory challenge, the names of two physicians, two attorneys and, if a hospital is also named in the claim submitted to the Division, one administrator of a hospital or person employed by a hospital in a management position, to serve on the screening panel for review of a claim of medical malpractice, but the representative of a hospital may not vote on any claim before the screening panel.
5. In cases involving dental malpractice, the Division shall randomly select, from the list of members of the tentative screening panel who have not been excused for cause or by a peremptory challenge, the names of two dentists and two attorneys to serve on the screening panel for review of the claim of dental malpractice.
6. The Division shall notify the parties and the members selected to serve on the screening panel immediately after it has made the selections. If any member so selected declines to serve, the Division shall immediately and randomly select a replacement from the list. The Division shall not release or disclose to any person the names of the members selected.
7. If, because of the exercise of challenges for cause or peremptory challenges or any other reason, no attorney, dentist, physician, administrator of a hospital or other person employed by a hospital in a managerial position designated pursuant to section 18 of this act remains available to serve on the screening panel, the Division shall immediately notify the Nevada Trial Lawyers Association, the Nevada State Medical Association, the Nevada Dental Association or the Nevada Hospital Association, as appropriate, and that association shall immediately designate a replacement from among its members. No person who is not so designated may serve on the screening panel.
Sec. 26. 1. The Division may, by certified or registered mail, issue subpoenas, as may be required by the screening panel, to compel the attendance of medical or dental experts, as appropriate, who may testify only with regard to the health care records of the claimant, and, as may be required by the parties or the screening panel, to compel the production of books, papers, health care records, statements of policy and procedure or other materials.
2. The Division shall keep the material so produced and make it available to the parties, upon request, for inspection or copying. If the material is reasonably capable of being copied, the Division shall provide a copy to the parties, upon request and receipt of a fee for the copying.
3. If the health care record of a claimant is illegible or difficult to read, the claimant may request an explanation of the health care record from the provider of health care who created the record. If the provider of health care fails or refuses to provide a satisfactory explanation, the claimant may request the Division to issue a subpoena to compel the provider of health care to provide a satisfactory explanation.
4. If any medical or dental expert refuses to attend or testify or if any person refuses to produce any materials as required by a subpoena, the Division may report to the district court by petition, setting forth that:
(a) Due notice has been given of the time and place of attendance of the medical or dental expert or for the production of the materials;
(b) The medical or dental expert or the person required to produce the materials has been subpoenaed by the Division pursuant to this section; and
(c) The medical or dental expert has failed or refused to attend or the person has failed or refused to produce the materials required by the subpoena, or has refused to answer questions propounded to him,
and asking for an order of the court compelling the medical or dental expert to attend and testify or the other person to produce the materials.
5. Upon receiving such a petition, the court shall enter an order directing the medical or dental expert or other person to appear before the court at a time and place to be fixed by the court in its order, the time to be not more than 10 days after the date of the order, and show cause why he has not attended or testified or produced the materials. A certified copy of the order must be served upon the medical or dental expert or other person.
6. If it appears to the court that the subpoena was regularly issued by the Division, the court shall enter an order that the medical or dental expert or other person appear at the time and place fixed in the order and testify or produce the required materials, and upon his failure to obey the order, the medical or dental expert or other person must be dealt with as for contempt of court.
Sec. 27. 1. A claim must be heard by a screening panel within 30 days after the panel is selected.
2. The screening panel shall consider all the documentary material, including the claim, answer and response, health care records and records of a hospital or office and the testimony of any medical or dental experts provided by the parties that the panel considers necessary, and shall determine only, from that evidence, whether there is a reasonable probability that the acts complained of constitute medical malpractice or dental malpractice and that the claimant was injured thereby. Except for the issue of whether there is a reasonable probability of medical malpractice or dental malpractice and whether the claimant was injured thereby, the screening panel shall not consider any pleading or paper to the extent that it addresses a legal issue presented by the claim or a legal argument of a party. The screening panel shall not consider challenges concerning any relevant statute of limitation relating to a claim before the panel.
3. Copies of the original claim and of the findings of the screening panel with regard to each matter considered by the panel must be forwarded to:
(a) In cases involving medical malpractice:
(1) The Board of Medical Examiners;
(2) The State Board of Osteopathic Medicine; and
(3) The county medical society of the county in which the alleged malpractice occurred.
(b) In cases involving dental malpractice, the Board
of Dental
Examiners of Nevada.
4. The Commissioner of Insurance shall mail to the parties a copy of the findings of the screening panel concerning the claim.
5. The written findings of the screening panel must be based upon a vote of the members of the screening panel made by written ballot, must be rendered within 5 days after the review and must be in substantially the following form:
(a) Based upon a review of the materials submitted by the parties and expert testimony (if any) we find that there is a reasonable probability of medical malpractice or dental malpractice and that the claimant was injured thereby;
(b) Based upon a review of the materials submitted by the parties and expert testimony (if any) we find that there is no reasonable probability of medical malpractice or dental malpractice; or
(c) Based upon a review of the materials submitted by the parties and expert testimony (if any) we are unable to reach a decision on the issue of medical malpractice or dental malpractice.
6. Whenever three members of the screening panel are unable to find that there is a reasonable probability of medical malpractice or dental malpractice and that the claimant was injured thereby or that there is no reasonable probability of medical malpractice or dental malpractice, the screening panel shall be deemed unable to reach a decision on the issue and shall make a finding to that effect.
Sec. 28. 1. If a claimant is 70 years of age or older or suffers from an illness or condition which raises a substantial medical doubt that the claimant will survive until a determination is made by a screening panel, the claimant may file a written request with the Division to give preference in scheduling the hearing of the claim filed by the claimant. The request must set forth facts showing that the claimant is 70 years of age or older or suffers from an illness or condition which raises a substantial medical doubt that the claimant will survive until a determination is made by a screening panel.
2. The Division shall schedule the hearing of claims for which preference has been granted pursuant to subsection 1 based on the order in which the Division received the requests for preference.
Sec. 29. 1. Upon the request of the Division or counsel for a patient, a custodian of any health care records shall not allow any person to review any of those records relevant to a claim filed with the Division before those records are transferred to a requesting party or the authority issuing the subpoena.
2. A violation of this section is punishable as a misdemeanor.
Sec. 30. 1. If a screening panel finds in favor of a claimant and a cause of action involving medical malpractice or dental malpractice is thereafter filed by the claimant in district court, a settlement conference must be held as provided in NRS 41A.081.
2. If the determination of the screening panel is not in favor of the claimant, the claimant may file an action in court. If the claimant does not obtain a judgment in his favor in court, the defendant must be awarded reasonable costs and attorney’s fees incurred after the date of filing the action in court.
3. If the screening panel is unable, for any reason, to reach a decision, the claimant may file a civil action or proceed no further with the claim.
4. If the claimant files a civil action in district court, a person may not be named as a party in the action unless the person was named as a party in the claim which was filed with the Division and considered by the screening panel.
Sec. 31. 1. Unless the written findings of a screening panel are not admissible pursuant to subsection 3 of section 16 of this act, in any action for medical malpractice tried before a jury, the following instructions must be given:
(a) If testimony of an expert was given at the review by the screening panel:
During the course of this trial certain evidence was admitted concerning the findings of a screening panel. The findings of the panel were based upon a review of the medical records of the claimant and the testimony of medical experts based upon the review by the experts of those records. These findings are to be given the same weight as any other evidence, but are not conclusive on your determination of the case.
(b) If testimony of an expert was not given at the review by the screening panel:
During the course of this trial certain evidence was admitted concerning the findings of a screening panel. The findings of the panel were based solely upon a review of the medical records of the claimant. These findings are to be given the same weight as any other evidence, but are not conclusive on your determination of the case.
2. Unless the written findings of a screening panel are not admissible pursuant to subsection 3 of section 16 of this act, in any action for dental malpractice tried before a jury, the following instructions must be given:
(a) If testimony of an expert was given at the review by the screening panel:
During the course of this trial certain evidence was admitted concerning the findings of a screening panel. The findings of the panel were based upon a review of dental records of the claimant and the testimony of experts based upon the review by the experts of those records. These findings are to be given the same weight as any other evidence, but are not conclusive on your determination of the case.
(b) If testimony of an expert was not given at the review by the screening panel:
During the course of this trial certain evidence was admitted concerning the findings of a screening panel. The findings of the panel were based solely upon a review of the dental records of the claimant. These findings are to be given the same weight as any other evidence, but are not conclusive on your determination of the case.
Sec. 32. A screening panel or any of its members acting pursuant to sections 12 to 32, inclusive, of this act that initiates or assists in any proceeding concerning a claim of medical malpractice or dental malpractice against a physician or dentist is immune from any civil action for that initiation or assistance or any consequential damages if the panel or members acted without malicious intent.
Sec. 33. 1. Except as otherwise provided in subsection 2 and except as further limited in subsection 3, in an action for damages for medical malpractice or dental malpractice where the alleged malpractice occurred on or after the effective date of this act, the noneconomic damages awarded to each plaintiff from each defendant must not exceed $350,000, except that if the plaintiff is not entitled to receive economic damages for lost wages the noneconomic damages awarded must not exceed $500,000.
2. In an action for damages for medical malpractice or dental malpractice where the alleged malpractice occurred on or after the effective date of this act, the limitation on noneconomic damages set forth in subsection 1 does not apply in the following circumstances and types of cases:
(a) A case in which the conduct of the defendant is determined to constitute gross malpractice; or
(b) A case in which, following return of a verdict by the jury or a finding of damages in a bench trial, the court determines, by clear and convincing evidence admitted at trial, that an award in excess of the limits on the amount of noneconomic damages that may be awarded to a plaintiff is justified because of exceptional circumstances.
3. Except as otherwise provided in subsection 4, in an action for damages for medical malpractice or dental malpractice where the alleged malpractice occurred on or after the effective date of this act, in the circumstances and types of cases described in subsections 1 and 2, the noneconomic damages awarded to each plaintiff from each defendant must not exceed the amount of money remaining under the professional liability insurance policy limit covering the defendant after subtracting the economic damages awarded to that plaintiff. Irrespective of the number of plaintiffs in the action, in no event may any single defendant be liable to the plaintiffs in the aggregate in excess of the professional liability insurance policy limit covering that defendant.
4. The limitation set forth in subsection 3 does not apply in an action for damages for medical malpractice or dental malpractice unless the defendant was covered by professional liability insurance at the time of the occurrence of the alleged malpractice and on the date on which the insurer receives notice of the claim, in an amount of:
(a) Not less than $1,000,000 per occurrence; and
(b) Not less than $3,000,000 in the aggregate.
5. This section is not intended to limit the responsibility of any defendant for the total economic damages awarded.
6. For the purposes of this section, “gross malpractice” means failure to exercise the required degree of care, skill or knowledge that amounts to:
(a) A conscious indifference to the consequences which may result from the gross malpractice; and
(b) A disregard for and indifference to the safety and welfare of the patient.
Sec. 34. NRS 41A.031 is hereby amended to read as follows:
41A.031 1. Except as otherwise provided in subsection
2 and except as further limited in subsection 3, in an action for damages for
medical malpractice or dental malpractice [,] where the alleged
malpractice occurred on or after October 1, 2002, but before the effective date
of this act, the noneconomic damages awarded to each plaintiff from each
defendant must not exceed $350,000.
2. In an action for damages for medical malpractice or
dental malpractice [,] where the alleged malpractice occurred on or
after October 1, 2002, but before the effective date of this act, the
limitation on noneconomic damages set forth in subsection 1 does not apply in
the following circumstances and types of cases:
(a) A case in which the conduct of the defendant is determined to constitute gross malpractice; or
(b) A case in which, following return of a verdict by the jury or a finding of damages in a bench trial, the court determines, by clear and convincing evidence admitted at trial, that an award in excess of $350,000 for noneconomic damages is justified because of exceptional circumstances.
3. Except as otherwise provided in subsection 4, in an
action for damages for medical malpractice or dental malpractice [,] where
the alleged malpractice occurred on or after October 1, 2002, but before the
effective date of this act, in the circumstances and types of cases
described in subsections 1 and 2, the noneconomic damages awarded to each
plaintiff from each defendant must not exceed the amount of money remaining
under the professional liability insurance policy limit covering the defendant
after subtracting the economic damages awarded to that plaintiff. Irrespective
of the number of plaintiffs in the action, in no event may any single defendant
be liable to the plaintiffs in the aggregate in excess of the professional
liability insurance policy limit covering that defendant.
4. The limitation set forth in subsection 3 does not apply in an action for damages for medical malpractice or dental malpractice unless the defendant was covered by professional liability insurance at the time of the occurrence of the alleged malpractice and on the date on which the insurer receives notice of the claim, in an amount of:
(a) Not less than $1,000,000 per occurrence; and
(b) Not less than $3,000,000 in the aggregate.
5. This section is not intended to limit the responsibility of any defendant for the total economic damages awarded.
6. For the purposes of this section, “gross malpractice” means failure to exercise the required degree of care, skill or knowledge that amounts to:
(a) A conscious indifference to the consequences which may result from the gross malpractice; and
(b) A disregard for and indifference to the safety and welfare of the patient.
Sec. 35. NRS 41A.097 is hereby amended to read as follows:
41A.097 1. Except as otherwise provided in subsection 3, an action for injury or death against a provider of health care may not be commenced more than 4 years after the date of injury or 2 years after the plaintiff discovers or through the use of reasonable diligence should have discovered the injury, whichever occurs first, for:
(a) Injury to or the wrongful death of a person occurring before October 1, 2002, based upon alleged professional negligence of the provider of health care;
(b) Injury to or the wrongful death of a person occurring before October 1, 2002, from professional services rendered without consent; or
(c) Injury to or the wrongful death of a person occurring before October 1, 2002, from error or omission in practice by the provider of health care.
2. Except as otherwise provided in subsection 3, an
action for injury or death against a provider of health care may not be
commenced more than
3 years after the date of injury or 2 years after the plaintiff discovers or
through the use of reasonable diligence should have discovered the injury,
whichever occurs first, for:
(a) Injury to or the wrongful death of a person occurring on or after October 1, 2002, based upon alleged professional negligence of the provider of health care;
(b) Injury to or the wrongful death of a person occurring on or after October 1, 2002, from professional services rendered without consent; or
(c) Injury to or the wrongful death of a person occurring on or after October 1, 2002, from error or omission in practice by the provider of health care.
3. This time limitation is tolled [for] :
(a) For any period during which the provider of health care has concealed any act, error or omission upon which the action is based and which is known or through the use of reasonable diligence should have been known to him.
(b) In any action governed by the provisions of sections 12 to 32, inclusive, of this act from the date on which a claimant files a claim for review by a screening panel until 30 days after the date on which the screening panel notifies the claimant, in writing, of its findings. The provisions of this paragraph apply to an action against the provider of health care and to an action against any person or governmental entity that is alleged by the claimant to be liable vicariously for the medical malpractice or dental malpractice of the provider of health care, if the provider, person or governmental entity has received notice of the filing of a claim for review by a screening panel within the limitation of time provided in subsection 1.
Sec. 36. NRS 49.245 is hereby amended to read as follows:
49.245 There is no privilege under NRS 49.225 or 49.235:
1. For communications relevant to an issue in proceedings to hospitalize the patient for mental illness, if the doctor in the course of diagnosis or treatment has determined that the patient is in need of hospitalization.
2. As to communications made in the course of a court-ordered examination of the condition of a patient with respect to the particular purpose of the examination unless the court orders otherwise.
3. As to written medical or hospital records relevant to an issue of the condition of the patient in any proceeding in which the condition is an element of a claim or defense.
4. In a prosecution or mandamus proceeding under
chapter 441A
of NRS.
5. As to any information communicated to a physician in an effort unlawfully to procure a dangerous drug or controlled substance, or unlawfully to procure the administration of any such drug or substance.
6. As to any written medical or hospital records which are furnished in accordance with the provisions of NRS 629.061.
7. As to records that are required by chapter 453 of NRS to be maintained.
8. If the services of the physician are sought or
obtained to enable or aid a person to commit or plan to commit fraud or any
other unlawful act in violation of any provision of chapter 616A, 616B, 616C,
616D or 617
of NRS which the person knows or reasonably should know is fraudulent or
otherwise unlawful.
9. In a review before a screening panel pursuant to sections 12 to 32, inclusive, of this act.
Sec. 37. Chapter 690B of NRS is hereby amended by adding thereto a new section to read as follows:
An insurer shall not take any retaliatory action,
including, without limitation, cancelling or failing to renew a policy of
insurance or renewing a policy of insurance with altered policy or contract
terms, against a physician or dentist who, during a settlement conference held
pursuant to
NRS 41A.081, indicates his desire to settle the claim for or within his policy
limits.
Sec. 38. NRS 690B.045 is hereby amended to read as follows:
690B.045 Except as more is required in NRS 630.3067 and 633.526:
1. Each insurer which issues a policy of insurance
covering the liability of a practitioner licensed pursuant to chapters 630 to 640,
inclusive, of
NRS for a breach of his professional duty toward a patient shall report to the
board which licensed the practitioner within [30] 45 days each
settlement or award made or judgment rendered by reason of a claim, if the
settlement, award or judgment is for more than $5,000, giving the name and
address of the claimant and the practitioner and the circumstances of the case.
2. A practitioner licensed pursuant to chapters 630 to
640, inclusive, of NRS who does not have insurance covering liability for a
breach of his professional duty toward a patient shall report to the board
which issued his license within [30] 45 days of each settlement
or award made or judgment rendered by reason of a claim, if the settlement,
award or judgment is for more than $5,000, giving his name and address, the
name and address of the claimant and the circumstances of the case.
3. These reports are public records and must be made available for public inspection within a reasonable time after they are received by the licensing board.
Sec. 39. NRS 690B.050 is hereby amended to read as follows:
690B.050 1. Each insurer which issues a policy of insurance
covering the liability of a physician licensed under chapter 630 of NRS or an
osteopathic physician licensed under chapter 633 of NRS for a breach of his
professional duty toward a patient shall report to the Commissioner within [30]
45 days each settlement or award made or judgment rendered by reason of
a claim, giving the name and address of the claimant and physician and the
circumstances of the case.
2. The Commissioner shall report to the Board of Medical Examiners or the State Board of Osteopathic Medicine, as applicable, within 30 days after receiving the report of the insurer, each claim made and each settlement, award or judgment.
Sec. 40. Chapter 695G of NRS is hereby amended by adding thereto a new section to read as follows:
1. Except as otherwise provided in subsection 3, each health care plan offered or issued by a managed care organization that contracts with providers of health care for the provision of health care services to insureds must provide that the managed care organization will enter into a contract with any provider of health care for the provision of covered health care services to its insureds if:
(a) The provider of health care is qualified under the laws of this state to provide such care; and
(b) The provider of health care agrees to accept the rates, terms and conditions established for other providers of health care by the managed care organization.
2. An evidence of coverage for a health care plan subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after the effective date of this act has the legal effect of including the provisions required by this section, and any provision of the evidence of coverage or renewal thereof that is in conflict with this section is void.
3. The provisions of this section do not apply to any plan for providing welfare benefits for employees of more than one employer as described in NRS 679B.139.
Sec. 41. NRS 41A.071 is hereby repealed.
Sec. 42. Sections 12 to 32, inclusive, of this act do not apply to an action involving medical malpractice or dental malpractice filed before the effective date of this act.
Sec. 43. 1. Until the Division of Insurance of the Department of Business and Industry collects sufficient fees to pay for the administrative costs of the screening panels established pursuant to sections 12 to 32, inclusive, of this act, the Division shall apportion such administrative costs among the Board of Medical Examiners, the State Board of Osteopathic Medicine and the Board of Dental Examiners of Nevada as follows:
(a) The Board of Medical Examiners shall pay a portion of the administrative costs based on the ratio of the number of physicians licensed pursuant to chapter 630 of NRS to the total number of physicians, osteopathic physicians and dentists licensed pursuant to the provisions of chapters 630, 631 and 633 of NRS.
(b) The State Board of Osteopathic Medicine shall pay a portion of the administrative costs based on the ratio of the number of osteopathic physicians licensed pursuant to chapter 633 of NRS to the total number of physicians, osteopathic physicians and dentists licensed pursuant to the provisions of chapters 630, 631 and 633 of NRS.
(c) The Board of Dental Examiners of Nevada shall pay a portion of the administrative costs based on the ratio of the number of dentists licensed pursuant to chapter 631 of NRS to the total number of physicians, osteopathic physicians and dentists licensed pursuant to the provisions of chapters 630, 631 and 633 of NRS.
2. Any money received by the Division of Insurance pursuant to the provisions of this section must be deposited with the State Treasurer for credit to the account for the Division of Insurance in the State General Fund. The administrative costs of the screening panels must be paid from the account.
3. If a board fails to pay its apportioned share of the administrative costs required by this section, the Commissioner of Insurance may refer the nonpayment to the Office of the Attorney General for collection of the apportioned share and any costs incurred.
4. For the purposes of this section, “administrative costs” means:
(a) All costs incurred to create the tentative screening panels, train the members of the tentative screening panels, appoint members to the screening panels and enable such members to carry out the duties of the screening panels; and
(b) Any other costs reasonably incurred in carrying out the purposes of sections 12 to 32, inclusive, of this act.
Sec. 44. 1. For a policy of insurance covering the liability of a practitioner licensed pursuant to chapter 630, 631, 632 or 633 of NRS for a breach of his professional duty toward a patient that is issued or renewed on or after the effective date of this act, the insurer shall reduce the premium for the policy to an amount which:
(a) Must be determined by the Commissioner of Insurance; and
(b) Must be less than the premium for the same coverage in effect on the effective date of this act.
2. If, on or after the effective date of this act, a practitioner licensed pursuant to chapter 630, 631, 632 or 633 of NRS applies for the first time for a policy of insurance covering the liability of the practitioner for a breach of his professional duty toward a patient, the premium for the policy:
(a) Must be determined by the Commissioner of Insurance; and
(b) Must be less than the premium for similarly situated risks in effect on the effective date of this act.
3. Any separate affiliate of an insurer, established after the effective date of this act, is subject to the provisions of this section and shall reduce its premiums to amounts which:
(a) Must be determined by the Commissioner of Insurance; and
(b) Must be less than the insurer’s premiums in effect on the effective date of this act.
4. In determining the amount by which premiums must be reduced pursuant to this section, the Commissioner of Insurance shall consider:
(a) Whether the reduction in premiums permits a fair and reasonable return to the insurer; and
(b) Whether the reduction in premiums is otherwise not confiscatory.
5. During the period beginning on the effective date of this act and ending on December 1, 2004:
(a) Premiums reduced pursuant to this section may be increased only in accordance with the provisions of this subsection or chapter 686B of NRS.
(b) An insurer subject to the provisions of this section may apply to the Commissioner of Insurance pursuant to this subsection to increase a premium set pursuant to this section if the premium set pursuant to this section fails to provide a fair and reasonable return to the insurer or is otherwise confiscatory.
(c) An application by an insurer pursuant to this subsection:
(1) Must be in writing;
(2) Must contain a detailed analysis of the reasons the premium set pursuant to this section fails to provide a fair and reasonable return to the insurer or is otherwise confiscatory, including, without limitation, relevant facts and provisions of law; and
(3) Must contain a proposed premium which:
(I) The insurer believes is the minimum premium that provides a fair and reasonable return to the insurer and is otherwise not confiscatory; and
(II) Is equal to or less than the premium charged by the insurer before the reduction pursuant to this section.
(d) After a hearing, the Commissioner of Insurance may approve the application of an insurer pursuant to this subsection, provided that the Commissioner:
(1) Finds that the premium set pursuant to this section fails to provide a fair and reasonable return to the insurer or is otherwise confiscatory; and
(2) Sets the premium at the minimum amount that provides a fair and reasonable return to the insurer and is otherwise not confiscatory.
(e) An insurer who submits an application pursuant to this subsection may charge the premium proposed in the application until the Commissioner of Insurance approves or disapproves the application, provided that:
(1) Upon approval of the application, the insurer immediately begins to charge the premium set by the Commissioner of Insurance pursuant to this subsection and refunds any excess portion of the previously paid premiums, with interest, to the person who paid the premiums; and
(2) Upon disapproval of the application, the insurer immediately begins to charge the premium set pursuant to this section and refunds the excess portion of the previously paid premiums, with interest, to the person who paid the premiums.
(f) If an insurer submits an application pursuant to this subsection, the insurer may not submit another application pursuant to this subsection regarding the same premium until no sooner than 60 days after the date of the decision of approval or disapproval of the Commissioner of Insurance with regard to the first application.
6. Notwithstanding any previous notice of cancellation or renewal, an insurer who has issued a policy of insurance covering the liability of a practitioner licensed pursuant to chapter 630, 631, 632 or 633 of NRS for a breach of his professional duty toward a patient that is in effect on the effective date of this act, and has a scheduled date for termination of the policy before December 1, 2004, shall not terminate or cancel that policy before December 1, 2004, or refuse to renew or extend that policy through November 30, 2004, for the purpose of avoiding the reduction in premiums required by this section.
7. An insurer who cancels or fails to renew policies of
insurance covering the liability of practitioners licensed pursuant to chapter
630, 631, 632 or 633 of NRS for a breach of their professional duty toward
patients at a rate that exceeds the insurer’s average monthly rate of
cancellation or failure to renew, respectively, for the preceding 24 months by
more than 10 percent during any 30-day period between the effective date of
this act and
December 1, 2004, is required to show cause immediately to the Commissioner of
Insurance why the insurer is not in violation of this section. Any violation of
this section is a violation of the Nevada Insurance Code. If the Commissioner
of Insurance determines that the reason for the increase in the rate of
cancellation of or failure to renew policies is an attempt to circumvent the
reduction in premiums required by this section, the Commissioner may take
appropriate disciplinary action.
8. For the purposes of this section:
(a) “Insurer” has the meaning ascribed to it in NRS 679A.100.
(b) “Premium” has the meaning ascribed to it in NRS 679A.115.
Sec. 45. 1. Not later than 90 days after the effective date of this act, an insurer subject to the provisions of section 44 of this act shall submit a proposal to reduce premiums to the lowest amount possible that continues to permit a fair and reasonable return to the insurer and is not otherwise confiscatory, taking into consideration the savings experienced and reasonably anticipated as a result of the passage of Assembly Bill No. 1 of the 18th Special Session of the Nevada Legislature.
2. Until the Commissioner of Insurance determines the amount by which an insurer must reduce premiums, the insurer may continue to charge the current premium. Upon such a determination of the Commissioner of Insurance, the insurer shall immediately begin to charge the premium set by the Commissioner of Insurance and refund any excess portion of the previously paid premiums, with interest, to the person who paid the premiums.
Sec. 46. Section 44 of this act expires by limitation on July 1, 2007.
Sec. 47. 1. At the general election held in 2004, the provisions of this act must be submitted to the registered voters of this state, pursuant to Section 2 of Article 19 of the Nevada Constitution, as a different and competing measure enacted by the Legislature on the same subject contained in the initiative petition that was presented to the Legislature by the Secretary of State on February 3, 2003.
2. If the initiative petition that was presented to the Legislature by the Secretary of State on February 3, 2003, is invalidated or for any other reason is not submitted to the registered voters of this state at the general election held in 2004, the provisions of this act also must not be submitted to the registered voters of this state at that general election and are thereafter void.
3. This act shall become law and take effect in the manner set forth in Section 2 of Article 19 of the Nevada Constitution.
TEXT OF REPEALED SECTION
41A.071 Dismissal of action filed without affidavit of medical expert supporting allegations. If an action for medical malpractice or dental malpractice is filed in the district court, the district court shall dismiss the action, without prejudice, if the action is filed without an affidavit, supporting the allegations contained in the action, submitted by a medical expert who practices or has practiced in an area that is substantially similar to the type of practice engaged in at the time of the alleged malpractice.”.
Amend the preamble of the bill, page 1, by deleting lines 1 through 13 and inserting:
“Whereas, The provision of quality medical care is essential to the general health and welfare of the residents of this state; and
Whereas, The practice of medicine is a mixture of art and science and is a dynamic and changing discipline based to a great extent on concepts of probability rather than on absolute certainty; and
Whereas, Regardless of the advances in the practice of medicine, unanticipated medical outcomes may occur during medical treatment because of the unavoidable effects of a disease or the unavoidable result of appropriate medical care; and
Whereas, Unanticipated medical outcomes do not automatically give rise to liability for damages; and
Whereas, Tens of thousands of patients are unfortunately injured each year as a result of inappropriate medical care; and
Whereas, This state is experiencing a health care crisis because increasing costs of malpractice insurance premiums have resulted in a potential breakdown in the delivery and quality of health care in this state; and
Whereas, Certain measures must be taken to provide protection for both the providers of health care and their patients to improve the quality of health care in this state; and
Whereas, A system for screening claims of malpractice by professionals with specialized training and experience will provide such protection for those providers and their patients and will eliminate frivolous claims and resolve meritorious claims; and
Whereas, Reasonable limitations on certain types of damages in malpractice actions will fairly balance the rights of those providers and their patients; and
Whereas, A system for reporting and investigating claims of medical malpractice will provide protection to the public by removing incompetent physicians from the medical profession; and
Whereas, A system for reducing premiums for malpractice insurance will ensure that competent physicians will continue to provide quality medical care in this state; now, therefore,”.
Amend the title of the bill to read as follows:
“AN ACT relating to health care; establishing screening panels for claims for medical malpractice or dental malpractice; increasing the limitation on the amount of noneconomic damages that may be awarded in an action for medical malpractice or dental malpractice in certain circumstances; requiring an investigation of a physician who has had three claims of malpractice reported to the licensing board; making various changes relating to the reporting of claims of medical malpractice; prohibiting an insurer from retaliating against a physician or dentist who indicates a desire to settle a claim during a settlement conference; requiring managed care organizations to enter into contracts for the provision of services with any willing provider in certain circumstances; requiring a temporary reduction in the premiums of malpractice insurance; providing a penalty; and providing other matters properly relating thereto.”.
Amend the summary of the bill to read as follows:
“SUMMARY—Makes various changes concerning actions for malpractice against providers of health care, removes certain restrictions by insurers on providers of health care and makes various other changes concerning providers of health care. (BDR 1‑248)”.
Assemblywoman Buckley moved the adoption of the amendment.
Remarks by Assemblymen Buckley, Hettrick, Mabey, Anderson, Leslie, Horne, Geddes, Collins, and Hardy.
Assemblyman Sherer requested that the following remarks be entered in the Journal.
Assemblywoman Buckley:
Thank you, Mr. Speaker. The first thing Amendment No. 774 does is delete SB 97 in its entirety. I would like to take a couple of minutes to hit the high points of SB 97 in order to discuss the rational of the Judiciary Committee in removing these items. The first item removed was a $350,000 hard cap. As everyone is aware, the Legislature met in a Special Session and enacted a series of caps. The first cap we enacted was an absolute, total immunity for any doctor who volunteered. The next cap was a $50,000 immunity cap for doctors who render emergency care in trauma-type situations. The last cap was a $350,000 with two exceptions. One exception was for gross negligence, which really doesn’t happen, and the second exception was, by clear and convincing evidence, where there were exceptional circumstances such as brain damage or paralysis. SB 97, in its original form, would have removed that exception, which in the opinion of many, would lead to an ultimate finding of unconstitutionality by the Nevada State Supreme Court.
One of the things discussed in the Special Session was that we should be very careful about balancing rights between trying to lower insurance premiums and the rights of someone who was injured and deserving of compensation under our system of justice. That is why we added a kind of relief valve for individuals with injuries such as brain damage. A final cap that was added to AB 1of the 18th Special Session said there was an overall cap of insurance policy limits. If you have a $1,000,000 insurance policy, with $900,000 in economic damages, all you can receive is $100,000 in noneconomic damages. We did a four-part cap. What SB 97 in its original form would do is to take away the exception for brain damage, paralysis, and exceptional circumstances. Eight states have already found caps unconstitutional. It is a very real danger. What would happen is, if this cap would be found unconstitutional, we would be back with no cap at all, rendering our situation more unstable than it is with the cap we have.
The next point of SB 97, which is deleted in the amendment, has to do with joint and several liability for economic damages. Proponents argue that we need to emulate California’s Medical Injury Compensation Reform Act (MICRA) law. Joint and several liability on economic damages is not part of California’s law. Eighty percent of all malpractice cases occur in a hospital. If, for example, a person ends up in a coma and there is joint and several liability, the hospital is only liable for their percentage, the nurses for theirs, one doctor for his, and another doctor for his, instead of focusing on making the patient, who did nothing wrong, whole. Instead of enabling them to get their medical bills paid, their wheelchair costs paid, this would say, “No, we don’t care about the hard economic costs. We are going to divvy it up, even if the patient isn’t made whole.” That is a risky proposition, which would mean any lawyer worth their salt would sue every person they could find to get each percentage, leading to more litigation. That is not a good result.
The next concept that was eliminated in SB 97 relates to periodic payments. When a jury renders a verdict and says, “Hey, you were wrong. You owe this person a certain amount,” that person gets the amount. In its original form, SB 97 said “No, no, no. We can decide to pay you in lump sums.” Why that is not a good idea is, first of all, a jury has already decided that they were due that amount. Second, the physician would end up being a judgment debtor for the entire time of the periodic payments, meaning the judgment would remain on their record as unpaid. If the victim needs their money for any sort of economic damages, a wheelchair or medical care, they may not be able to get it.
The collateral source rule is the next part of SB 97 that was eliminated. We have a collateral source rule in Nevada. What that does is after a jury trial, if there is a judgment awarded, any insurance company who paid out health insurance deducts that amount from the verdict. There is no double-dipping in Nevada. In its original form, SB 97 would let the jury know you have insurance. The jury would not be told that the doctor has insurance, just the patient. Our scheme is better. It prevents double-dipping and it doesn’t create an uneven playing field.
The last part of SB 97, the statute of limitations, was reduced to a year. That is just to hurt people and cut them off from filing a claim. What the amendment does, in its form, is replace this with a more holistic remedy to the problem that is facing us. It was offered by the Coalition for Quality Healthcare, consisting of groups consisting of AARP, Nevada Social Workers, and others. It would offer the voters a choice.
There are many different opinions as to how we can stabilize our malpractice environment and ensure better health care for all Nevadans. One approach has already been qualified to go to the voters for consideration on the 2004 ballot. This would give the voters another choice. It reaffirms AB 1 of the 18th Special Session and all of the caps that were outlined and already approved by this Legislature. It raises the cap to $500,000 for children, seniors, and housewives, those who do not have economic damages. It reinstitutes the successful medical legal screening panel to weed out frivolous lawsuits, which is something many of us in this Chamber did not want to eliminate, but were asked to eliminate by the physicians who now have reconsidered. It requires a mandatory investigation when doctors are involved in multiple litigation. It requires the board to do an investigation to see if appropriate disciplinary action is needed. And lastly, it creates more access to physicians by having patients be able to access more doctors and their health care plan. Patients now are not in the drivers’ seats when it comes to the physician of their choice. Health care plans drop physicians after a patient has established a bond with the physician. There are many who say one of the reasons why we have more litigation is because there is no longer a bond between the physician and his patient because a physician may have 3.5 seconds before they can move to the next patient due to the rules that the HMOs have put on them. This provision in the amendment will put the patient in the driver’s seat and let the patient have more access to medical care. A comprehensive, balanced approach to health care and respect for people’s rights will, in the long run, lead to a better health care system. That is why I request your support on this amendment to SB 97.
Assemblyman Hettrick:
Thank you, Mr. Speaker. I rise in opposition of this amendment. We agree on some of the things that are in the amendment. I believe the medical screening panels would be effective and should go back in. We are seeing an explosion of malpractice cases throughout Nevada and I believe medical screening panels would be an appropriate addition; so that part we would agree upon. “Any willing provider” sounds good and feels good, but the very reason it doesn’t work is that when you do that you lower the number of patients who go to a doctor who agreed to accept a lower price in return for seeing more patients. If he doesn’t see the patients he can’t offer the lower price, therefore, if you put in “any willing provider,” you are going to raise the cost of medical coverage for everyone because the doctors will not be able to accept as low a price to provide medical care. It sounds good and feels good but it doesn’t work very well. It will cost people in the state of Nevada money.
This amendment raises caps. While again, it sounds good and we worry about economic damages, those are imputed and raising the cap brings back the uncertainty of what this law would do. This adds disciplinary action for doctors, as well, and requires changes in the way that is done. I think that has a negative impact on the law in Nevada as it stands.
The big argument we have had over and over again in the State is if we wait and see if AB 1 of the 18th Special Session works, we would have certainty and ultimately rates would go down. Here we are proposing to change things again and we are just going to continue the uncertainty and rates won’t go down. We have an opportunity to pass a bill that mimics, very closely, MICRA in California and we know that works. Their medical malpractice rates run at an average of about a third of the state of Nevada. If we would enact that law now instead of waiting for this thing to go to the ballot, we could save all Nevadans and doctors insurance premium costs, and save good quality health care for the citizens of this state. I urge my fellow colleagues not to support this amendment.
Assemblyman Mabey:
Thank you, Mr. Speaker.
Let me speak as Doctor Mabey, not as Assemblyman Mabey. This amendment is bad
for the citizens of this great State and is bad for your constituents. What
good is Nevada Check Up if there are fewer pediatricians to see your children?
What good is
Senior Rx if there are fewer internists to write their prescriptions? What good
is health insurance if you can’t afford it? What good is Baby-to-Baby if there
are fewer obstetricians and you can’t receive care? What good is
Family-to-Family if there are fewer family practitioners and you can’t make an
appointment? What good is malpractice insurance if a doctor can’t afford it or
there aren’t malpractice insurance companies to sell the insurance?
This amendment, if passed, will restrict access to medical care, especially for the poor and less fortunate, because it will lead to fewer doctors. It has been my honor to serve as a doctor. No one, not anyone, knows what it is like to be a doctor. It is a sacred calling and duty. I have spent many days and nights in the hospital. I have delivered thousands of babies. It is an awesome privilege. I have sweated and prayed for my patients that I would do the right thing and that they would benefit by what I did. Mr. Speaker, there were those times that had I not been there a father and mother would have not had a christening, but rather a funeral. They would not have seen their child grow up but only wondered what might have been. Mr. Speaker, had I not been there, a father would have had to rear his child alone without his wife.
Mr.
Speaker, in my opinion, this amendment is the worst amendment of this entire
session. This amendment will not improve access to care but instead will worsen
it. Please do not be on record for worsening the crisis. I encourage you to
vote no on the amendment. Thank you,
Mr. Speaker.
Assemblyman Anderson:
Thank you, Mr. Speaker. I rise in support of the amendment. Clearly, there were two eloquent speakers ahead of me. During the Special Session we put forth Assembly Bill 1. We came up with what we hoped to be a solution to a genuine crisis. All of us recognize that the physicians that treat us are doing the very best they can. They are indeed gifted and talented people that we have confidence in and trust. In fact, if we listen to their advice we would be much better off. They care about us and look out for us. In thinking about the physicians who have treated me in my lifetime, each of them was a caring individual. It is not those physicians that cause us to worry. Our worry is to the physicians who, unfortunately, cause the disruptive attitude, the litigations, make serious errors, and cause great damage to both the individual patients and to their colleagues because of increased insurance rates. The crisis, I think, is twin, and while some would point to California as a model, I have always rejected the ideas of California. Not because it is California but because inflation, in this particular case, would change circumstances from then to now so that the rates would have to be higher. We sit in a different economic atmosphere. We have an environment that is different physically, economically, politically, socially, and in every other conceivable way. The Sierras do more than separate us from California; they separate us from a different kind of life and view. We rest upon our rugged individualism, a belief that Nevadans like to keep alive. When Nevada stepped off into its medical screening in the 80s, and we were well served, did it need to be fixed? Absolutely. Did we need to turn to what California was doing? Absolutely not. The insurance crisis has brought us to the point that we are now. To castigate this all on bad doctors is wrong. To castigate it on an overlitigious society is wrong. I believe, as I have for several sessions, that the problem rests with insurance companies. This amendment attempts to address part of that problem. That is the reason I believe it is a good piece of legislation and should go forward. Do I believe we are finished with this issue? The answer to that is no.
Assemblywoman Leslie:
Thank you, Mr. Speaker. I rise in support of this amendment. I would like to specifically address the part of the amendment that has the “any willing provider” clause in it. “Any willing provider” sounds good and feels good because it is good for the patient and the consumer. It provides consumers with choice. It increases patient access to timely and convenient care from the doctor of their choice. The only argument we heard against this is cost. The cost that is seldom figured in, because it is hard to quantify, is the cost that a patient incurs when they are constantly changing doctors. Who pays for the charts to be copied? Who pays for the drug regimens that have to be changed? What happens to the patients that fall between the cracks? What happens when, instead of getting in to see the new doctor, concerns have to be handled over the phone? These costs are real costs and have to be figured into the health plans. When patients have a trusted relationship with their physician there are fewer lawsuits and better compliance. If a patient has to constantly switch health plans and their doctors because of it, they are going to lose the doctors they have a long-standing relationship with. You or I may not find that terribly burdensome, but somebody with a serious and chronic illness may. Someone with a serious mental illness who has a long-standing relationship with their doctor may be devastated. Let’s pass this amendment with the “any willing provider” language and give these folks the peace of mind that their doctor will not be taken away from them by their insurance company for whatever reason. I urge your support.
Assemblyman Horne:
Thank you, Mr. Speaker. I rise in support of this amendment. Our colleague from District 2, as you can tell, is very passionate about his profession and I am sure that he is a very good physician. As everyone knows, my wife just gave birth and we love our obstetrician. We drove clear across the Valley just to see her and delivered in a hospital on the other side of the Valley just to make sure she was our physician. Unfortunately, not all the doctors are that good. Unfortunately, even good physicians are negligent sometimes. When that happens patients who are harmed by these doctors should be made whole.
In regard to caps, SB 97, in its original form, made no exceptions no matter how much a person has suffered: $350,000. “I don’t care how extreme my negligence was”: $350,000. That is just bad policy. As for several liability, under the original SB 97, doctors would want to be only liable for their percentage of their negligence, which sounds fair to everyone. However, you have to remember that public policy is to make the patient, who has done nothing wrong, whole. As the Majority Leader stated, if the original bill were to pass, a good lawyer would go after every person that is responsible for that harm and every single percentage. It doesn’t stop there. Currently a lawyer does not go after a physician’s personal assets but that will change. I don’t believe that is where anyone wants to go. That is why attorneys buy insurance as well. The definition of personal negligence, in its current form, seems to be that doctors want to require the showing of proximate cause for it to be professional negligence. This could result in the finding that no one is responsible. Imagine that you are the harmed patient and your job is to show proximate cause of damage caused by the physician. As any physician will tell you, it is difficult to show exactly what happened in that procedure that caused the harm. A plaintiff attorney would have to convince a jury to say how else did it happen, but in SB 97, in its original form, that almost holds no water because it says a patient has to show proximate cause and so he loses. It doesn’t show how many doctors, nurses, or medical experts visited that patient. The reasonable care, skill, and knowledge is the better definition. It goes to what the medical professional is supposed to do. It limits attorneys’ fees and contingency fees. Contingency fees, let us not forget, open up the possibility for someone who is harmed, and has no money, to afford an attorney. There are many people who are harmed by bad doctors who can’t afford an attorney. Law firms who practice in this area front the money. Litigation, as everyone knows, costs a lot of money. If you take that away, you take away the access to these patients who have been harmed and done nothing more than seek medical help.
For a long time I have heard nothing but physicians screaming, and rightfully so, they are not being paid for services rendered. What they are getting paid is slowly being diminished by insurance companies. The answer to that, they think, would be to limit attorneys’ fees, which is wrong.
In regard to periodic payments, is a physician’s insurance company willing to pay interest on a plaintiff’s award? If a person gets an award of $1,000,000, the original bill says the insurance company can determine whether or not to pay periodically. That is unfair because if I need the money for a future procedure I need the money now. If they are going to hold the remainder of the money that has already been awarded, I haven’t seen any proposals that there would be any interest paid. It should be paid.
As far as collateral source payments, you can’t ride on the coattails of the premiums that the patient has been paying. The way I read the bill that is exactly what you would be able to do, regardless of what the insurance was for. Many of us know of insurances that advertise that if you are off work we will pay you “X” amount of money for a period of time until you are back to work. Under the original SB 97 doctors would be able to say to a jury, “Hey, this bill has already been paid and I should be relieved of that payment.” You shouldn’t be because you are still liable and you shouldn’t be able to walk away from it because someone else has already picked up the bill. Is it a good policy to let someone say they are not responsible because it is already paid? Everyone asks if AB 1 of the 18th Special Session is sufficient to allow these premiums to come down. I heard the Minority Leader say that we are changing it without giving it time and that is what we are trying to do with this amendment. I disagree and believe that is what SB 97 is attempting to do. SB 97 is attempting to change what was done in that Special Session. We have all heard in committees the insurance industry say they don’t know, that even if we did everything, whether or not the insurance rates would come down; and if so, it would probably take at least three to five years. This is paramount to the old movies where you saw the volcano erupt and the people would take a virgin and throw her into the volcano hoping that the volcano wouldn’t erupt. It still rumbled and so they would take another virgin up there. We have to let it work and see what happens. I stand in support.
Assemblyman Geddes:
Thank you, Mr. Speaker. I rise in opposition to this amendment. With all due respect to the great arguments made by my colleagues from Las Vegas and Sparks, I live in northern Nevada and 3 ½ years ago I was trying to find an Obstetrician/Gynecologist (OB/GYN) for my pregnant wife. We had a hard time finding a good one. It finally took a recommendation from a friend to a cousin to finally get a good doctor. When we had to be rushed to the hospital at 6:00 a.m., as my wife had Hemolysis Elevated Liver Enzymes, Low Platelet Count, HELLP Syndrome, and I was looking at losing my wife and my child in a matter of moments, I was very thankful to have my OB/GYN on rotation at the hospital. When the nurses told him he was nuts to do the blood test looking for HELLP Syndrome, I am glad he was there to say, “No, she has the symptoms. We need to look at this.” I was able to have my wife and my son, after three weeks in intensive care, come out of that hospital happy and healthy and my family complete. I cannot imagine not having an OB/GYN and having to go to that emergency room at 6:00 a.m. that morning, not having those tests done and losing my family. I am opposed to this amendment. Thank you.
Assemblyman Collins:
Thank you, Mr. Speaker. I support this amendment. During the Special Session I had a picture of a real pretty girl named Savannah on my desk. I have taken that picture away but I would be glad to bring it back. She is my niece, my younger brother’s daughter.
My brother and his wife knew each other several years and then married. They decided to have a child and they did, in the middle of Las Vegas, in one of the finest hospitals. They had a little girl that will never speak, never call them Mom and Dad, never walk, and will probably not even fully sense being around her parents. This child is fed with a tube in her stomach and has periodic surgeries and takes tons of medicines for all kinds of things. Is there a cap on their lives? What is that worth for them for the next 20 or 30 years or however long this child might live? They will be, around the clock, every four hours, feeding her. Is there a cap on the lives that were harmed by a doctor who just kept doing what he did? That lawsuit has been filed and I believe it is a legitimate lawsuit. Doctors are going to come here and they are going to do what is right, just as we have heard from folks here. When they deliberately do something wrong there is no limit. Thank you.
Assemblyman Hardy:
Thank you, Mr. Speaker. I would recognize the sincerity, compassion, and eloquence that have been shared today. I would be derelict in my duty if I did not speak. I think there are not many doctors who are virgins, but they feel that they have been cast into the volcano. The same angst that we feel when one of ours has been injured is shared by the physician, the nurse, the health team worker, who has to help care for people who are injured in any way. When we consider that California has done certain things to get to the patient who has been injured quicker, with available means, then that is one of the things we would like to see. That is what the track record of MICRA has done. The initiative petition that was trying to mirror what was done in SB 97, probably to increase or decrease the time it would take to be effective to get predictability in the same venue or means as California. We do not hear of doctors leaving California. We do not hear about an access-of-care crisis in California. We do not hear the “patients” not having access to care by a good attorney in California. The timing is an issue that we could move forward with an intact SB 97.
The other thing that concerns me is the hope that is needed by medical care providers to stay in Nevada and to be recruited to Nevada and to continue to practice the skills that they have. We have doctors who are giving up certain areas of their practice, so we are getting into a literal crisis of access to care. This amendment would prolong that and would be a problem. I would be opposed to the amendment and I think there are things we need to look at. I recognize there are good things in SB 97 and the amendment that is proposed but those things could have been, were, and still could be addressed in other bill drafts. The issue of pain and suffering as a cap is a real issue. I don’t think doctors are anxious for economic damages to be capped. You can do the statistics and find how many babies are born with cerebral palsy through no fault of anyone. It happens. An insurance product that allowed for a no-fault purchase where a child could be covered for their life and the families financial means to take care of the child is something that needs to be explored. I would, again, compliment the decorum, the sincerity, and the collegiality that we felt during this discussion and I appreciate and feel honored to be amongst all of you. Thank you, Mr. Speaker.
Assemblymen Hettrick, Angle and Sherer requested a Roll Call vote on Amendment No. 774 to Senate Bill No. 97.
Roll call on Amendment No. 774 to Senate Bill No. 97:
Yeas—24.
Nays—Andonov, Angle, Beers, Brown, Carpenter, Christensen, Geddes, Goicoechea, Grady, Griffin, Gustavson, Hardy, Hettrick, Knecht, Mabey, Marvel, Sherer, Weber—18.
Amendment adopted.
Bill ordered reprinted, re-engrossed, and to third reading.
MOTIONS, RESOLUTIONS AND NOTICES
Assemblywoman Buckley moved that Senate Bill No. 370 just returned from the printer, be placed on the General File.
Motion carried.
Assemblyman Goldwater moved that Senate Bill No. 319 be taken from its position on the General File and placed at the top of the General File.
Motion carried.
Mr. Speaker announced if there were no objections, the Assembly would recess subject to the call of the Chair.
Assembly in recess at 7:51 p.m.
ASSEMBLY IN SESSION
At 7:52 p.m.
Mr. Speaker pro Tempore presiding.
Quorum present.
general file and third reading
Senate Bill No. 319.
Bill read third time.
The following amendment was proposed by the Committee on
Commerce and Labor:
Amendment No. 904.
Amend the bill as a whole by renumbering section 1 as sec. 1.5 and adding a new section designated section 1, following the enacting clause, to read as follows:
“Section 1. NRS 680A.310 is hereby amended to read as follows:
680A.310 NRS 680A.300 does not apply to any of the following:
1. Life insurance and annuities.
2. Health insurance.
3. Policies covering property in transit while in the possession or custody of any common carrier, or the rolling stock or other property of any common carrier employed by it in the operation and maintenance of its plant and business as a common carrier of freight or passengers, or both.
4. Reinsurance or retrocessions made by or for authorized insurers.
5. Bid bonds issued in connection with any public or private contract.
6. A policy issued to a risk retention group, as defined in NRS 695E.110, or to a member of a risk retention group.
7. A policy issued to a person who is not a resident of this state.”.
Amend sec. 10, page 4, by deleting lines 7 and 8 and inserting:
“(f) Any credit information that reflects extraordinary circumstances in the life of an applicant or policyholder, including, without limitation, divorce and catastrophic illness.”.
Amend the title of the bill, first line, after “insurance;” by inserting: “providing an exception to the counter-signature requirement for certain types of insurance;”.
Assemblyman Goldwater moved the adoption of the amendment.
Remarks by Assemblyman Goldwater.
Amendment adopted.
Bill ordered reprinted, re-engrossed, and to third reading.
Senate Bill No. 494.
Bill read third time.
Roll call on Senate Bill No. 494:
Yeas—42.
Nays—None.
Senate Bill No. 494 having received a constitutional majority, Mr. Speaker pro Tempore declared it passed.
Bill ordered transmitted to the Senate.
Senate Joint Resolution No. 3.
Resolution read.
Roll call on Senate Joint Resolution No. 3:
Yeas—42.
Nays—None.
Senate Joint Resolution No. 3 having received a constitutional majority, Mr. Speaker pro Tempore declared it passed, as amended.
Resolution ordered transmitted to the Senate.
Senate Joint Resolution No. 4.
Resolution read.
Roll call on Senate Joint Resolution No. 4:
Yeas—41.
Nays—None.
Not Voting—Angle.
Senate Joint Resolution No. 4 having received a constitutional majority, Mr. Speaker pro Tempore declared it passed, as amended.
Resolution ordered transmitted to the Senate.
Senate Bill No. 55.
Bill read third time.
Roll call on Senate Bill No. 55:
Yeas—42.
Nays—None.
Senate Bill No. 55 having received a constitutional majority, Mr. Speaker pro Tempore declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 136.
Bill read third time.
Remarks by Assemblyman Geddes.
Roll call on Senate Bill No. 136:
Yeas—42.
Nays—None.
Senate Bill No. 136 having received a constitutional majority, Mr. Speaker pro Tempore declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 192.
Bill read third time.
Remarks by Assemblywoman Chowning.
Roll call on Senate Bill No. 192:
Yeas—19.
Nays—Anderson, Andonov, Angle, Arberry, Beers, Brown, Carpenter, Christensen, Conklin, Geddes, Gibbons, Giunchigliani, Goicoechea, Goldwater, Grady, Griffin, Gustavson, Hardy, Knecht, Mabey, Perkins, Sherer, Weber—23.
Senate Bill No. 192 having
failed to receive a two-thirds majority,
Mr. Speaker pro Tempore declared it lost.
Senate Bill No. 240.
Bill read third time.
Roll call on Senate Bill No. 240:
Yeas—42.
Nays—None.
Senate Bill No. 240 having received a constitutional majority, Mr. Speaker pro Tempore declared it passed.
Bill ordered transmitted to the Senate.
Senate Bill No. 309.
Bill read third time.
Roll call on Senate Bill No. 309:
Yeas—42.
Nays—None.
Senate Bill No. 309 having received a constitutional majority, Mr. Speaker pro Tempore declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 280.
Bill read third time.
Roll call on Senate Bill No. 280:
Yeas—41.
Nays—None.
Not Voting—Knecht.
Senate Bill No. 280 having received a constitutional majority, Mr. Speaker pro Tempore declared it passed.
Bill ordered transmitted to the Senate.
Senate Bill No. 351.
Bill read third time.
Roll call on Senate Bill No. 351:
Yeas—42.
Nays—None.
Senate Bill No. 351 having received a two-thirds majority, Mr. Speaker pro Tempore declared it passed.
Bill ordered transmitted to the Senate.
Senate Bill No. 174.
Bill read third time.
Roll call on Senate Bill No. 174:
Yeas—42.
Nays—None.
Senate Bill No. 174 having received a constitutional majority, Mr. Speaker pro Tempore declared it passed.
Bill ordered transmitted to the Senate.
Senate Bill No. 460.
Bill read third time.
Roll call on Senate Bill No. 460:
Yeas—42.
Nays—None.
Senate Bill No. 460 having received a constitutional majority, Mr. Speaker pro Tempore declared it passed, as amended.
Bill ordered transmitted to the Senate.
Assembly Bill No. 534.
Bill read third time.
Roll call on Assembly Bill No. 534:
Yeas—42.
Nays—None.
Assembly Bill No. 534 having received a two-thirds majority, Mr. Speaker pro Tempore declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 425.
Bill read third time.
Roll call on Senate Bill No. 425:
Yeas—41.
Nays—Gustavson.
Senate Bill No. 425 having received a two-thirds majority, Mr. Speaker pro Tempore declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 491.
Bill read third time.
Roll call on Senate Bill No. 491:
Yeas—42.
Nays—None.
Senate Bill No. 491 having received a constitutional majority, Mr. Speaker pro Tempore declared it passed, as amended.
Bill ordered transmitted to the Senate.
Mr. Speaker pro Tempore announced if there were no objections, the Assembly would recess subject to the call of the Chair.
Assembly in recess at 8:09 p.m.
ASSEMBLY IN SESSION
At 8:10 p.m.
Mr. Speaker presiding.
Quorum present.
Senate Bill No. 370.
Bill read third time.
Remarks by Assemblymen Griffin, Goldwater, Carpenter, Goicoechea, and Beers.
Roll call on Senate Bill No. 370:
Yeas—23.
Nays—Andonov, Angle, Beers, Brown, Carpenter, Christensen, Geddes, Gibbons, Goicoechea, Grady, Griffin, Gustavson, Hardy, Hettrick, Knecht, Mabey, Marvel, Sherer, Weber—19.
Senate Bill No. 370 having received a constitutional majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
MOTIONS, RESOLUTIONS AND NOTICES
Assemblywoman Buckley moved that Senate Bills Nos. 97 and 319 just returned from the printer, be placed on the General File.
Motion carried.
general file and third reading
Senate Bill No. 97.
Bill read third time.
Roll call on Senate Bill No. 97:
Yeas—24.
Nays—Andonov, Angle, Beers, Brown, Carpenter, Christensen, Geddes, Goicoechea, Grady, Griffin, Gustavson, Hardy, Hettrick, Knecht, Mabey, Marvel, Sherer, Weber—18.
Senate Bill No. 97 having received a constitutional majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
Senate Bill No. 319.
Bill read third time.
Remarks by Assemblymen Goldwater, Hettrick, and Leslie.
Roll call on Senate Bill No. 319:
Yeas—37.
Nays—Andonov, Brown, Christensen, Griffin, Weber—5.
Senate Bill No. 319 having received a constitutional majority, Mr. Speaker declared it passed, as amended.
Bill ordered transmitted to the Senate.
Mr. Speaker announced if there were no objections, the Assembly would recess subject to the call of the Chair.
Assembly in recess at 8:24 p.m.
ASSEMBLY IN SESSION
At 8:30 p.m.
Mr. Speaker presiding.
Quorum present.
UNFINISHED BUSINESS
Signing of Bills and Resolutions
There being no objections, the Speaker and Chief Clerk signed Assembly Bills Nos. 153, 205, 294, 304, 315, 361, 419, 437, 485, 488, 507, and 522; Assembly Joint Resolution No. 4; Senate Bills Nos. 7, 8, 40, 43, 48, 50, 70, 83, 89, 105, 186, 197, 248, 266, 276, 281, 283, 299, 310, 313, 315, 322, 362, 363, 373, 378, 383, 387, 396, 401, 405, 408, 410, 422, 427, 429, 437, and 483; Senate Concurrent Resolutions Nos. 7, 10, and 19.
GUESTS EXTENDED PRIVILEGE OF ASSEMBLY FLOOR
On request of Assemblywoman
Angle, the privilege of the floor of the Assembly Chamber for this day was
extended to Dennis Flannigan and
Bruce Rodela.
On request of Assemblyman
Geddes, the privilege of the floor of the Assembly Chamber for this day was
extended to Remi Surges,
Jennifer Grano, Conrad Kiyoshi, Jimmy Rodarte, Cory Bliss, Cristal Becerra,
Marisa D’Mateo, Dawn Hollins, Elizabeth Gonzales, and Dean Stonecipher.
On request of Assemblywoman
Gibbons, the privilege of the floor of the Assembly Chamber for this day was
extended to Joan Mack and
Paul Erickson.
On request of Assemblyman
Grady, the privilege of the floor of the Assembly Chamber for this day was
extended to Elizabeth Sanderson,
Jason Sanderson, and John Sanderson.
On request of Assemblyman
Mabey, the privilege of the floor of the Assembly Chamber for this day was
extended to Sarah Mabey and
Jacob Mabey.
Assemblyman Oceguera moved that the Assembly adjourn until Saturday, May 24, 2003, at 10:30 a.m.
Motion carried.
Assembly adjourned at 8:31 p.m.
Approved: Richard D. Perkins
Attest: Jacqueline Sneddon
Chief Clerk of the Assembly