MINUTES OF THE
SENATE Committee on Commerce and Labor
Seventy-second Session
April 29, 2003
The Senate Committee on Commerce and Labor was called to order by Chairman Randolph J. Townsend, at 7:07 a.m., on Tuesday, April 29, 2003, in Room 2135 of the Legislative Building, Carson City, Nevada. The meeting was videoconferenced to the Grant Sawyer State Office Building, Room 4412, 555 East Washington Avenue, Las Vegas, Nevada. Exhibit A is the Agenda. Exhibit B is the Attendance Roster. All exhibits are available and on file at the Research Library of the Legislative Counsel Bureau.
COMMITTEE MEMBERS PRESENT:
Senator Randolph J. Townsend, Chairman
Senator Warren B. Hardy II, Vice Chairman
Senator Ann O'Connell
Senator Raymond C. Shaffer
Senator Joseph Neal
Senator Michael Schneider
Senator Maggie Carlton
GUEST LEGISLATORS PRESENT:
Assemblywoman Christina R. Giunchigliani, Assembly District No. 9
Assemblyman Wendell P. Williams, Assembly District No. 6
STAFF MEMBERS PRESENT:
Scott Young, Committee Policy Analyst
Courtney Wise, Committee Policy Analyst
Kevin Powers, Committee Counsel
Makita Schichtel, Committee Secretary
Laura Adler, Committee Secretary
OTHERS PRESENT:
Patricia K. Elzy, Lobbyist, Planned Parenthood Mar Monte, and Planned Parenthood Rocky Mountain dba Planned Parenthood of Southern Nevada
Fred L. Hillerby, Lobbyist, Nevada State Board of Pharmacy
Bobbie Gang, Lobbyist, Nevada Women’s Lobby
Samuel P. McMullen, Lobbyist, Retail Association of Nevada, Nevada Council of Chain Drug Stores, and LensCrafters
V. Robert Payant, Lobbyist, Nevada Catholic Conference
Kathleen Rossi, Nevada Right to Life
Janine Hansen, Lobbyist, Nevada Eagle Forum
David K. Schumann, Lobbyist, Independent American Party of Nevada
Don Nelson, Nevada Life Issues Forum and Education
Jan Gilbert, Lobbyist, Progressive Leadership Alliance of Nevada
Alfredo Alonso, Lobbyist, Nevada State Board of Optometry
Kurt Alleman, O.D., Nevada State Board of Optometry
Michael Alonso, Lobbyist, Nevada State Board of Opticians
David B. Stuart, President, Board of Dispensing Opticians
Jeanette K. Belze, Lobbyist, Nevada Ophthalmological Society
Mary Lau, Lobbyist, Retail Association of Nevada
George A. Ross, Lobbyist, LensCrafters
Scott Helkaa, Program Director, Ophthalmic Technology Programs, Community College of Southern Nevada
K. Neena Laxalt, Lobbyist, Nevada Dental Hygienists Association
Caryn Solie, R.D.H., Government Affairs Council, Nevada Dental Hygienists’ Association
Chairman Townsend opened the hearing on Assembly Bill (A.B.) 144.
ASSEMBLY BILL 144 (1st Reprint): Prohibits pharmacist from refusing to fill or refill prescription under certain circumstances. (BDR 54-210)
Patricia K. Elzy, Lobbyist, Planned Parenthood Mar Monte, and Planned Parenthood Rocky Mountain dba Planned Parenthood of Southern Nevada, read from prepared testimony (Exhibit C). Ms. Elzy said Planned Parenthood supports this bill that holds a pharmacist to a duty to dispense legitimate prescriptions as prescribed.
Senator Hardy inquired as to what kind of leeway a doctor might have to write a prescription.
Ms. Elzy said she could not answer for a doctor, but thinks a pharmacist should fill a legally-written prescription.
Fred L. Hillerby, Lobbyist, Nevada State Board of Pharmacy (NSBP), said the board was approached about the issue, and wrote a regulation allowing a pharmacist not to fill a prescription, but requiring the pharmacist to give the prescription to someone who would fill it. That regulation was not adopted because of labor and management issues.
Senator O'Connell said she wanted to know on what other grounds a pharmacist could refuse service to a customer.
Mr. Hillerby responded service could be refused if the medication is contraindicated to other medication the person is taking, if the prescription is suspected of being fraudulent, or if tampering with the prescription is suspected. He said these are all grounds for refusal to fill a prescription.
Senator O'Connell noted there are some occasions not to fill a prescription.
Mr. Hillerby stated part of the requirements for pharmacists is patient consulting. The pharmacist would review the dosage instructions, side effects, and other drugs that may interact with the prescription.
Bobbie Gang, Lobbyist, Nevada Women’s Lobby, stated she supports A.B. 144. She said a doctor who writes a prescription for a patient as part of their treatment, should not have that legal prescription denied by a pharmacist, except as indicated in section 1, subsection 1, of the bill.
Samuel P. McMullen, Lobbyist, Retail Association of Nevada, Nevada Council of Chain Drug Stores, and LensCrafters, stated he had worked through the bill on the Assembly side and has no opposition to the bill as written.
V. Robert Payant, Lobbyist, Nevada Catholic Conference, read from prepared text (Exhibit D) and stated the amended bill passed the Assembly with a split vote making the bill controversial. Mr. Payant said the bill was originally written to protect pharmacists who, in good conscience, could not fill certain prescriptions, but it has been completely turned around. He asked that section 1, subsection 2, paragraph (d), of the original bill be restored to read, “Filling or refilling the prescription would require the pharmacist to violate a genuine principle or tenet of good conscience held by the pharmacist.”
Senator Carlton commented there is primarily one drug of concern not stocked by a pharmacy but comes from the doctor’s office. She surmised Mr. Payant was being proactive in case that drug or any other should wind up at a pharmacy or a drug was inappropriately prescribed.
Mr. Payant responded that was correct. He said there was also the morning‑after pill. He added the bill would apply to any pharmacist who was a conscientious objector.
Kathleen Rossi, Nevada Right to Life, stated in her written testimony (Exhibit E) that she strongly objects to A.B. 144.
Janine Hansen, Lobbyist, Nevada Eagle Forum, said it was stated that a patient’s health comes first. She said the Constitution of the United States of American comes first. Ms. Hansen read highlighted passages from the U.S. Constitution (Exhibit F) in support of her opposition to the bill. She noted the Constitution of the State of Nevada also incorporated similar wording. She emphasized passing A.B. 144 in its present form would abrogate her fundamental right of conscience and freedom of choice.
David K. Schumann, Lobbyist, Independent American Party of Nevada, stated the bill would set a terrible precedent when government determines what individuals must do regarding their conscience. He said a pharmacist who declines to fill certain prescriptions has a principled objection to the point of reducing income. He pointed out that in no way does one pharmacist refusing to fill a prescription stop a person from getting a drug; there are many other pharmacists who will. Mr. Schumann stated when government says a person cannot choose to not dispense a drug, that is a precedent, and others would ask for laws requiring people to behave in a certain way. This is how freedom gets nibbled away in tiny pieces. He said the United States government recognizes the individual right to be a conscientious objector in time of war, and provides for it by law. He requested the amendment be added to the bill or the bill be killed.
Senator Neal queried if a prescription comes from a doctor, then the pharmacist is put in the position of filling the prescription. Mr. Payant answered that was a pharmacist’s job.
Senator Neal asked if he saw a pharmacist about an ailment, could the pharmacist prescribe a medicine for him. Mr. Payant replied it could not be a controlled-prescription drug. He said the pharmacist could suggest an over‑the‑counter remedy.
Senator Neal said if a licensed doctor wrote a legal prescription, the pharmacist would respond to that. Therefore, the pharmacist does not have his own position because he was in a profession requiring a response to an order. Mr. Payant responded that was the basic job of a pharmacist.
Ms. Rossi stated a pharmacist has a particular body of knowledge to let the doctor know the medication may not be right for a particular patient.
Senator Neal said he wanted to know what the pharmacist would do if the doctor said that is the medication he wants the patient to have.
Ms. Rossi responded the pharmacist and doctor usually discuss the medication. She stated if the issue was a prescription specifically for an abortion, then the pharmacist would see himself or herself as complicit in that act.
Senator Neal questioned whether the pharmacist would refuse if the prescription were to save the patient’s life. Ms. Rossi said the pharmacist should still have the right of conscience regarding personal involvement.
Don Nelson, Nevada Life Issues Forum and Education (Nevada LIFE), read testimony (Exhibit G) against the bill passed by the Assembly, and in support of amending the bill to include a conscience clause for pharmacists.
Senator Neal said he wanted to know if other states have a conscience clause. He wondered if he took a prescription to a pharmacy that was part of the Aryan Nation and they refused service, if they should keep their license.
Mr. Payant responded there are many states with conscience clauses in various areas of medical care even for hospitals.
Mr. Schumann said a conscience clause does not involve racial discrimination. He said no judge would read the language of that conscience clause as supporting the ability to discriminate solely on that basis. He stated, “it would not fly.”
Ms. Hansen said, in response to Senator Neal’s inquiry, that it is known the Nazi or Aryan Nation group was protected in free speech and allowed to march through Jewish neighborhoods. She said most people would think the group obnoxious, but their right of free speech and conscience was defended. It was defended because if not, then there would be no free speech or right of conscience for anyone else.
Senator Neal inquired if Ms. Hansen was suggesting the bill was a free-speech issue. Ms. Hansen affirmed that it absolutely was a First Amendment issue, and that is why she included it in her testimony.
Senator Neal said he wanted to know if any court had rendered a decision on this. Ms. Hansen replied she did not know, but was sure the right of conscience would have been discussed by many courts.
Assemblywoman Christina R. Giunchigliani, Assembly District No. 9, stated Assembly Committee on Commerce and Labor did deal with a conscience clause, but as the debate continued it was decided the issue was about professional judgment and not religious conscience. The bill does not pertain to RU-486, which is only available in clinics and doctor’s offices. This bill is not about abortion, Assemblywoman Giunchigliani stated, the bill is about the doctor-patient relationship. She noted the vote in the Assembly was 26 for and 16 against. She pointed out A.B. 144 is about a job to dispense legal prescriptions written by a doctor for a patient. She asked that the bill be passed as amended.
Jan Gilbert, Lobbyist, Progressive Leadership Alliance of Nevada, said surveys show Nevada comes in last in women’s health. This bill is one way to provide for women’s health care needs. She pointed out that part of government’s duty was to regulate businesses for the benefit of the public. She said it is important for pharmacists to fill prescriptions. Ms. Gilbert stated she supported the bill.
Senator Neal said one side says it is a pharmacist’s duty to fill a lawfully written prescription. The other side says the pharmacist also has a right not to participate in an act against his or her conscience.
Ms. Gilbert responded if there are contraindications, the pharmacist usually consults with the prescribing physician. She said she believed it was not the pharmacist’s right to not fill a prescription because it was for a contraceptive.
Chairman Townsend said he would close the hearing on A.B. 144 and open the hearing on A.B. 275.
ASSEMBLY BILL 275 (1st Reprint): Makes various changes relating to dispensing opticians and optometrists. (BDR 54-1218)
Alfredo Alonso, Lobbyist, Nevada State Board of Optometry, said the bill clarifies “initial fitting” conflicting with the definition of an optometrist within statute.
Senator Neal said he wanted to know the circumstances requiring legislation. Mr. A. Alonso replied the bill was to make sure properly qualified individuals were dispensing. The bill corrects a loophole so only dispensing by prescription or by optometrist can be done.
Senator Neal said as he understands it is a tri-profession of the ophthalmologist, optometrist, and optician; and the latter fills the prescriptions written by the other two. He said he would like to know the particular circumstances initiating this bill.
Kurt Alleman, O.D., Nevada State Board of Optometry, said the bill would allow a patient to receive their contact lenses from whatever source they would like. He said the optometrist examines eyes and prescribes glasses, and the ophthalmologist is a medical doctor who treats eye diseases, prescribes medications, and also performs surgery.
Michael Alonso, Lobbyist, Nevada State Board of Opticians (NSBO), said the bill was to put an end to the discussion of who can do what. The definition of an initial fitting is a compromise to make it clear what pertains to the health of the eye, and who can write prescriptions. He said the NSBO supported the bill.
Senator Neal inquired as to how many groups in the State fit contact lenses.
David B. Stuart, President, Nevada State Board of Dispensing Opticians, said a pharmacist could fill a fully-written prescription for contact lenses. An optician could fill general or detailed prescriptions for lenses and the initial fitting. The bill clarifies up to what point an optician can function without crossing into an optometrist’s area. He said the optician fits the lenses then usually refers the patient back to the prescribing doctor.
Mr. A. Alonso stated the ability of the optician to dispense was being removed from the Nevada Revised Statutes (NRS) chapter covering optometrists because optometrist was being redefined to eliminate a conflict.
Senator Neal inquired of the three professions, which benefits from the bill.
Dr. Alleman replied the bill defines exactly what each profession could do so the consumer is informed of the process for contact lenses. This would aid the consumer in getting the best service and treatment, and the best price.
Chairman Townsend closed the hearing on A.B. 275 and opened the hearing on A.B. 452.
ASSEMBLY BILL 452 (1st Reprint): Makes various changes regarding dispensing opticians. (BDR 54-541)
Mr. M. Alonso stated the bill was sponsored by the Board of Dispensing Opticians to clear up issues. He said section 2 would combine the licenses into one license for dispensing spectacles and contact lenses. The opticians who only have a license for spectacles would be grandfathered, and could get the one license to include contact lenses. He said the bill is intended to ensure consumers in Nevada are provided with a uniform knowledge of dispensing and to allow for streamlined licensing by the board.
Mr. M. Alonso said sections 3 and 4 are for disciplinary matters. Most of the consumer complaints are about retailers with opticians and apprentices dispensing glasses or contact lenses. The board has its hands tied because they cannot take action against anyone other than a natural person who is subject to the licensing requirements under chapter 637 of NRS.
He said section 6 addresses allowing ophthalmic dispensing by a student enrolled in a course of study for ophthalmic dispensing for educational purposes. This section deals with the accredited programs by the federal Commission on Opticianry Accreditation. One issue that arose after the bill left the Assembly was the accredited program offered by the Community College of Southern Nevada. He said a letter (Exhibit H) from Professor Scott Helkaa of the Community College of Southern Nevada makes it clear the course is available throughout the State via Internet, and videoconferencing. A letter (Exhibit I) from Paul B. Davis, Ph.D., Professor of Political Science and International Terrorism, who is also on the Board of Dispensing Opticians, provides information on how to receive the educational requirements to be a dispensing optician.
Mr. M. Alonso stated sections 8 through 12 do away with the apprenticeship program in order to increase the standards for opticians in Nevada, and make sure all licensed opticians in this State have the same requirements for education and continuing education. He said the problem is apprentices can work under the supervision of an optometrist, ophthalmologist, or licensed dispensing optician who can only supervise two people. However, he said there are some establishments that have more than two apprentices and they are not being supervised. The board put in a phaseout of 3 years to allow time for apprentices to acquire an optician license. The rest of the language in the bill is general cleanup. Mr. M. Alonso said the board wanted to make sure this bill did not apply to ophthalmic dispensing done under the supervision of a licensed physician, surgeon, or optometrist, and would also exempt pharmacists who fill prescriptions by ophthalmologists or optometrists.
Mr. Stuart said the optician chapter of NRS came into effect in 1951 before there were optometrists. The intent is no matter what eye care provider a person goes to, they are guaranteed the same standard of service. He said a person can purchase $14 contacts at Wal-Mart, and should be able to rely on the standardized education of the optician that verifies it is the right prescription.
Chairman Townsend asked for clarification if it was all right to buy over‑the‑counter contact lenses. Mr. Stuart answered the proper prescription pharmacies can dispense prepackaged contact lenses.
Mr. M. Alonso stated fitting lenses and filling prescriptions are two different concepts. He explained once a prescription has been filled and the contacts fitted, the patient could get refills by phone, at a drug store, or over the Internet. He said in sections 3 and 4 the natural-person wording is retained and under chapter 637 of NRS the employer-retailer could now be fined for allowing an unlicensed person to fit and dispense.
Chairman Townsend asked if someone could explain what the complaints were about. Mr. Stuart responded that an eye patient’s chance of being waited on by a licensed optician by a mass producer or mall retailer is 1 in 3. He said 80 percent of the complaints are about spectacles and 20 percent about contact lenses.
Senator Neal said he wanted to know who would train apprentices.
Mr. Stuart said the goal is to phase out apprenticeships over the next 3 years, and for people to receive a 2-year associate applied science degree. The course is available online through a community college. He said, currently, apprentice testing scores are 50 percent at best. He said 60 percent of apprentices do not renew their licenses because they do not have enough motivation or education.
Senator Neal inquired as to who supervises an apprentice, and how long was the training period. Mr. Stuart replied opticians, optometrists, and ophthalmologists can supervise. He said the apprentice period is 3 years including 1 year of customer interaction.
Senator Neal said he wanted to know if an optician could prepare the lens to correct vision, and would the apprentice be included in the process.
Mr. Stuart acknowledged that an optician is qualified to grind the lens. He said an apprentice is not always present. He explained many retailers fit the frames and send the glass to a laboratory to be ground to the prescription. He said about 75 percent of the prescriptions are sent to a laboratory to be filled.
Senator Neal asked how many laboratories there were in the State. Mr. Stuart answered there were six laboratories.
Senator Hardy asked who established the curriculum.
Mr. Stuart responded the apprenticeship program was established by the Board of Dispensing Opticians. He said because of low-test scores the board instigated a career progression program that allows for more formal training. He said the apprentice had to pass the program first before taking the board’s examination.
Senator Hardy stated apprentices have no class time, just on-the-job experience. He said he wanted to know if there were other problems in addition to the apprentice-ratio issue. Mr. Stuart explained it was not a regular apprenticeship program and that was the problem. He said the trend around the country was leaning towards an associate’s degree.
Senator Hardy inquired what position apprentice status has regarding wages. Mr. Stuart replied apprentices receive 60 percent to 70 percent less than a licensed optician, which is a prime reason for abuse by retailers.
Senator Carlton stated the difference was people without health care or who have low incomes usually go to the mall retailer for their glasses, and are not always receiving the full health care for their eyes.
Mr. Hillerby stated he had a proposed amendment (Exhibit J) to section 5 defining the initial fitting including the refractive process and eye health. He said all the boards support the bill with the amendment.
Jeanette K. Belze, Lobbyist, Nevada Ophthalmological Society, said there was no reference in NRS 630 to visual analysis. She said visual analysis has no meaning in NRS 630 and she did not want to create a problem by its introduction. She said the society was in support of the bill, but wanted clarification on the terminology.
Mr. Hillerby said NRS 630 describes what a licensed optometrist or medical doctor could do and that included eye health. He said he believed the attorney’s intent when writing the amendment was to say, as a result of their license, these are the things they can do.
Ms. Belze stated she had no objection.
Kevin Powers, Committee Counsel said:
I believe the intent of the amendment is to make clear that someone who is licensed as a dispensing optician pursuant to chapter 637 can’t undertake any activity for which a license is required under chapter 630 or 636 of NRS. It’s the idea to make a clear delineation that there are activities under 630 and 636 that require a separate license that a dispensing optician cannot perform.
Mr. M. Alonso said he agreed with Mr. Hillerby’s and Ms. Belze’s comments, but he wanted to emphasize the bill has to do with the things optometrists and ophthalmologists do to get to the prescription stage that an optician cannot do.
Chairman Townsend said he would temporarily hold A.B. 452 and open the hearing on A.B. 119.
ASSEMBLY BILL 119 (1st Reprint): Revises provisions governing specification of expiration date for certain drugs or medicines. (BDR 54-238)
Assemblyman Wendell P. Williams, Assembly District No. 6, stated the bill was presented by a group of seniors in his district. He said it was found some pharmacists were reducing the expiration date on medications different from the manufacturer’s date. This action increased the frequency of refills resulting in increased expense to the customer. Assemblyman Williams stated the bill requires the manufacturer’s expiration date for the drug or medicine to be on the label.
Senator Hardy inquired if there was any other reason for changing the date.
Assemblyman Williams responded there was no other reason. In contact with the pharmaceutical industry, he said, it was indicated changing the recommended expiration dates were isolated incidents. They supported the idea of putting it into law.
Senator Hardy asked if there was a compelling reason why these pharmacists changed the expiration date.
Mr. Hillerby said it was standard for a prescription to be issued for 1 year regardless of the manufacturer’s expiration date. The reason was so the patient could be reevaluated for the effectiveness of the medication or contraindication with other medications. It is not economically driven.
Senator Neal said he was under the impression the manufacturer’s expiration date was for the efficacy of the drug. Mr. Hillerby stated that was correct. He noted medications in liquid form could change the efficacy with temperature.
Senator Neal said he wanted to know if the bill would affect the board’s ability to act in any other areas. Mr. Hillerby replied that ethics was a different issue. He said the bill would not affect the board’s ability to take action in other areas. He stated the board is neutral on the issue.
Mary Lau, Lobbyist, Retail Association of Nevada (RAN), said she had a handout (Exhibit K) saying the manufacturer’s date on an item is based on the assumption the recommended storage conditions or the container would not change.
Chairman Townsend said he would close A.B. 119 and reopen A.B. 452.
George A. Ross, Lobbyist, LensCrafters, said in the last 2 decades the multiple store optical firms such as LensCrafters have attracted a lot of customers with a new type of optical service with convenient locations, extended hours, and discounted prices. He said to put things in perspective, 49 states use apprenticeship programs to develop dispensing opticians; only Rhode Island has schooling and no apprenticeship program. Only 21 states license dispensing opticians. Only 22 schools in the country are accredited to provide dispensing opticians. He said the program at the Community College of Southern Nevada has only 15 slots. If there is no apprenticeship program, there will be a major problem in optical stores of obtaining new employees to provide customer service in their locations, at those hours, at low prices.
Mr. Ross said the main issue is the problem optical stores would have in getting adequate workers. He said the apprenticeship program offers an opportunity for people who, for reasons of their own personal circumstances, financial, family, or geographical cannot get to a school, but over a 3-year period they can get practical hands-on training and experience more so than in school. There is a big difference in performing a task under classroom conditions, and doing it in the real world. The apprentice system seems to have worked well in 49 states for a long time. He said customer relations and customer satisfaction are key to learning and to the apprenticeship program.
Senator Hardy said he wanted to know how extensive the apprenticeship program is in practice, and if it is not being abused. Mr. Ross replied his client believes they have an excellent training program, and their biggest concern is losing people to competitors. He pointed out no matter how that person is trained, they still have to pass the test for licensure.
Senator O'Connell said there was testimony that 80 percent of complaints are about spectacles, and asked if there was information on those complaints relating more to one business than another.
Mr. Stuart responded the board keeps records of violations and complaints. He said LensCrafters has one of the better programs in the industry. However, their apprentices test with the American Board of Opticians, which is a standard test across the country for competency, is not equal to Nevada’s test.
Senator O'Connell asked for comment on Nevada’s college program with only 15 slots.
Mr. Stuart stated the program is in its infancy and space will grow as the program grows. He noted most of the curriculum is offered through compressed video and the Internet. He explained the compressed video is where students in Reno would be in a classroom to receive the broadcast as it is done now, and the Internet access is unlimited. Mr. Stuart said portions of the test can be taken by remote, but the student would have to test in person for fitting and adjusting the glasses.
Senator Carlton said she wanted to know what type of program the 49 states have.
Mr. Ross answered the people go through an apprentice program to become dispensing opticians. In 29 states there is no licensing program, just training to the company’s standards. The other 21 states, including Nevada, have a licensing program. He said LensCrafters believes Nevada has one of the most stringent requirement programs in the country. He said since 1995 LensCrafters has nothing in their files regarding disciplinary complaints from the board.
Senator Carlton said there is a recommended ratio of apprentices to opticians, and wanted to know how many dispensing opticians LensCrafters employs and the ratio of apprentices to opticians.
Mr. Ross replied LensCrafters follows Nevada law of two apprentices to one dispensing optician, but did not know the total number of opticians employed. He said LensCrafters has one store in Reno and four stores in the Las Vegas area.
Senator Carlton said she would like further information on LensCrafters’ apprentice program and how much supervision is provided. Mr. Ross said he would provide that information.
Senator O'Connell said her concern was comparing the number of current apprentices with only 15 class spaces at the community college and how long it would take to get the people through the program.
Mr. Stuart answered some of the people like staying at the apprenticeship level and would not take the class. Many of the others, knowing they have 3 years to complete the program, would wait until the last moment causing a rush at the end. He noted less than 15 people a year take the State’s test.
Senator Neal inquired if the bill would be acceptable to Mr. Stuart if the portion dealing with apprentices was removed.
Mr. Stuart said his primary goal is to make sure the board has a right to protect the public by the ability to enforce laws against unlicensed people and businesses in violation. He said his other goal was to ensure qualified people in the industry, and he was open to the best way to achieve that goal. Mr. Stuart added a lot of employees are reluctant to be whistle-blowers at the risk of their job and wages. The consumer has no idea of the competency of the person serving them, and under a store’s guarantee the apprentice gets to redo and eventually gets it right.
Senator Neal noted in most cases the customer would know before they left the store whether the prescription was filled correctly. He said he questions the business saying there were no complaints since 1995.
Senator Hardy asked if the issue with the board was that the optical businesses were not conducting the apprenticeship programs the way they should, and the board did not have the ability to monitor the program.
Mr. Stuart answered he did have a concern for the ratio of apprentices to opticians. He said the board does not at this time have a step-by-step program primarily because the statute only says in order to dispense contact lenses the person must be apprenticed, and goes no further. He added the chapter still relates to the old days and not to today’s situations.
Vice Chairman Hardy stated he wanted to be sure they were not throwing something out and at the same time he wanted to get a grip on apprentice status and what it means. He said it sounded like LensCrafters has a good program and has taken the initiative, but there are others who do not take the same care.
Mr. Ross said section 4, subsection 1, paragraph (b), addresses subjective aspects regarding what an employer knew, and said the “or should have known” should be removed, and remove the second sentence through line 14 to make it clear it is knowledge. He said the $10,000 fine would be the highest in the country, and a $1000 fine was more typical. Mr. Ross stated he submitted other recommended amendments (Exhibit L) to A.B. 452.
Ms. Lau said the difficulty may be in the word “apprentice.” She said the pharmacy board dealt with a similar issue and developed a definition for pharmacy technician with number of hours of on-the-job training. The bill seems to presume every person working in an optical store wants to become an optician and there needs to be staff behind that optician. She suggested working within the existing law through regulations for a solution.
Vice Chairman Hardy said these people are actually trainees not apprentices.
Ms. Lau stated RAN was definitely against the $10,000 fine amount. She stated for the record she wanted to acknowledge and thank Mr. M. Alonso for his work on this bill. Mr. Ross said he would also add his thanks.
Scott Helkaa, Program Director, Ophthalmic Technology Programs, Community College of Southern Nevada, said he was there to answer any questions on the accessibility of the program, and to offer clarification should it be needed in addition to the information already provided (Exhibit H) to the committee.
Senator Hardy said he would be interested in receiving information from Mr. Helkaa on programs in other states.
Mr. Helkaa said he would forward the information. He said he noted concern expressed over the limited number of seats in the program. He said the 15 seats was an initial number to get the program started to ensure sufficient facilities, equipment, and qualified instructors. The college is capable of a higher number of students through the compressed video and Internet access. He said the Internet program was developed by a consortium of optical schools and has been in place for 3 years in Virginia and Florida. Both states have 45 people on the Internet, 20 in a specific classroom site, and additional people using the compressed video. He said this is a track record for using the system designed at the college that any individual could have access to training wherever they are located across the State. Training in the Reno area is also offered through Truckee Meadows Community College, and currently there are eight students using the compressed video and Internet. Mr. Helkaa stated all the resources are designed toward a 2-year associate degree.
Vice Chairman Hardy closed the hearing on A.B. 452 and opened A.B. 489.
ASSEMBLY BILL 489 (1st Reprint): Revises provisions relating to dental hygiene. (BDR 54-185)
K. Neena Laxalt, Lobbyist, Nevada Dental Hygienists Association, said her client and the Board of Dental Examiners of Nevada have worked collaboratively to develop this bill since the last session.
Caryn Solie, R.D.H., Government Affairs Council, Nevada Dental Hygienists’ Association, read from prepared testimony (Exhibit M) in favor of A.B. 489.
Senator Carlton said this is the same language put into S.B. No. 133 of the 71st Session regarding the temporary licensure provision. She asked for confirmation that there are two dental hygiene schools in Nevada, graduating around 50 students a year. She also wanted to know the cost of the program.
Ms. Solie replied there are two dental hygiene schools with approximately 33 students enrolled in the Community College of Southern Nevada program, and 12 in the Truckee Meadows Community College program. She said she was not sure of the cost but thought it was between $6500 and $8000 for the 2‑year associate degree with prerequisite courses completed before submitting the application.
Senator Carlton asked what the ratio was of dental hygienists to dentists. Ms. Solie stated it was about even with approximately 1100 licenses per profession.
Senator Carlton said she wanted to know the cost of the examination. Mr. Hillerby responded the initial examination fee was $125 as was the annual renewal fee. He said in NRS 631.345 the licensure maximum is $150. He added a standard fee was also the intent in this bill.
Senator Carlton stated if the same regulatory scheme as the dental board uses was applied to dental hygienists, the cost would almost prohibit dental hygienists from working in Nevada.
Ms. Solie said she had heard, during discussion for licensure of dentists, that the cost would be $500 for the investigative process. The investigation cost is greatly offset when comparing it to the dental hygienists having to bring a patient for demonstration during testing, the cost of travel, room, and board.
Mr. Hillerby said the sunset date in the bill correlates with other related dates. He said he would like to add the idea of licensure by credential as done in S.B. No. 133 of the 71st Session was because of the shortage, and a way of recognizing qualified people from out of state without having to go through an examination.
Chairman Townsend closed the hearing on A.B. 489, and said he would take motions.
SENATOR SCHNEIDER MOVED TO DO PASS A.B. 119.
SENATOR CARLTON SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY.
*****
SENATOR CARLTON MOVED TO DO PASS A.B. 275.
SENATOR HARDY SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY.
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Senator Hardy stated there were some amendments to A.B. 452 to work through.
Senator Neal stated he would like to see the word “apprenticeship” removed from A.B. 452.
Chairman Townsend said once all parties got together, he believed the issue of apprenticeship could be worked out.
SENATOR CARLTON MOVED TO DO PASS A.B. 489.
SENATOR SCHNEIDER SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY.
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Senator Hardy said he could not support A.B. 144 because there are businesses that have to make decisions on who they serve. He added when he was in his teens working in his father’s shop, a group of antiwar protesters’ car broke down in the lot. His father instructed everyone to push the car off the lot. He stated he believed a business and its employees should have the ability to conscientiously object to those sorts of things.
Senator Carlton said, with respect to her colleague, she agreed with Assemblywoman Giunchigliani that the decision is between the patient and their doctor. She said there are safeguards in the law that if a pharmacist does have a problem, they can contact the prescribing doctor.
SENATOR CARLTON MOVED TO DO PASS A.B. 144.
SENATOR SCHNEIDER SECONDED THE MOTION.
Senator Neal said he had looked at the case Assemblywoman Giunchigliani had submitted (Exhibit N) of Gennock v. Warner-Lambert Company regarding the duty of a pharmacist. The ruling went against the pharmacist having the right to not carry out the duty of a pharmacist once the patient received the prescription from their doctor. He stated he would support the bill.
Chairman Townsend said, as he remembered the testimony, the pharmacist refused to fill the prescription, but did not refer the patient to another pharmacy. He said forget amendment rights; the act was bad business and inappropriate behavior. He said he respects the individual’s right to be conscientious, but they have a responsibility to refer the patient to another pharmacy. Now there is a bill that has turned into 2 years’ worth of law we all have to live under because someone did not have the professional courtesy of at least referring the patient. He added if people would exercise a little common courtesy in their dealings with each other, a substantial number of bills would not exist.
THE MOTION CARRIED. (SENATORS O'CONNELL AND HARDY VOTED NO.)
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There being no further business, Chairman Townsend adjourned the meeting at 9:49 a.m.
Laura Adler,
Committee Secretary
APPROVED BY:
Senator Randolph J. Townsend, Chairman
DATE: