MINUTES OF THE
SENATE Committee on Human Resources and Facilities
Seventy-second Session
April 23, 2003
The Senate Committee on Human Resources and Facilities was called to order by Chairman Raymond D. Rawson, at 1:58 p.m., on Wednesday, April 23, 2003, in Room 2135 of the Legislative Building, Carson City, Nevada. Exhibit A is the Agenda. Exhibit B is the Attendance Roster. All exhibits are available and on file at the Research Library of the Legislative Counsel Bureau.
COMMITTEE MEMBERS PRESENT:
Senator Raymond D. Rawson, Chairman
Senator Barbara K. Cegavske, Vice Chairman
Senator Maurice E. Washington
Senator Dennis Nolan
Senator Joseph Neal
Senator Bernice Mathews
Senator Valerie Wiener
GUEST LEGISLATORS PRESENT:
Assemblyman Richard D. Perkins, Assembly District No. 23
Assemblywoman Christina R. Giunchigliani, Assembly District No. 9
Assemblyman Roderick (Rod) R. Sherer, Assembly District No. 36
Assemblywoman Ellen Marie Koivisto, Assembly District No. 14
STAFF MEMBERS PRESENT:
H. Pepper Sturm, Committee Policy Analyst
Cynthia Cook, Committee Secretary
OTHERS PRESENT:
James F. Nadeau, Lobbyist, Washoe County Sheriff’s Office
Gary H. Wolff, Lobbyist, Teamsters Local 14
Michelle M. Youngs, Deputy, Washoe County Sheriff’s Office
Ronald P. Dreher, Lobbyist, Peace Officers Research Association of Nevada Adrienne Abbott Gutierrez, Nevada State Chairman, Emergency Alert System
Robert David Fisher, Lobbyist, Nevada Broadcasters Association
Steve Schorn, Vice President, Cox Communications
Sarah Sherer
Lawrence P. Matheis, Lobbyist, Nevada State Medical Association
Marcia de Braga
Jeff Braccini
Buffy Gail Martin, Lobbyist, American Cancer Society/Reno
Roy Barraclough, Project Development Officer, Rural Health Management Corporation, and Rural Health Services of Nevada, Incorporated
Robin L. Keith, Lobbyist, Nevada Rural Hospital Partners Foundation
Mary G. Griffith, R.N., Health Research Analyst, Health Division, Department of Human Resources
Chairman Rawson:
I will open the hearing on Assembly Bill (A.B.) 322.
ASSEMBLY BILL 322 (1st Reprint): Creates Statewide Alert System for the Safe Return of Abducted Children. (BDR 38-253)
Assemblyman Richard D. Perkins, Assembly District No. 23:
Assembly Bill 322 is about increasing the possibility that abducted children in Nevada will be rescued and safely returned to their families. Also, it is about protecting the reputation of our State by insuring Nevada will not be a safe haven for criminals who have abducted children. Without this legislation it is possible criminals will come into our State seeking to avoid detection because a Statewide Amber Alert system is not in place.
The Amber Alert plan was created in 1996 as a legacy to 9-year-old Amber Hagerman. Residents in the community contacted radio stations in the Dallas/Fort Worth area suggesting they broadcast special alerts over the airwaves to prevent such occurrences in the future. The Dallas/Fort Worth Association of Station Managers, teamed with local law enforcement agencies in North Texas, developed this innovative early-warning system to help find abducted children. Since the original Amber Alert plan was established, 66 modified versions have been adopted at local, regional, and statewide levels. There are 24 programs operating on a statewide level. In Nevada, several versions of an Amber Alert plan are operating.
The U.S. Department of Justice reports the following statistics concerning child abductions; there are 114,600 attempted abductions of children by nonfamily members each year. Only 4600 nonfamily abductions are reported to law enforcement each year. Two-thirds or more of the abductions involve sexual assault. There are 74 percent of the children murdered by nonfamily members killed within the first 3 hours of their abduction. The statistics illustrate time is the enemy in the search for missing children.
The National Center for Missing and Exploited Children endorsed the use of Amber Alert plans to assist in the most serious child abduction cases. The center is promoting the use of such alert plans nationwide. The Amber Alert program has been credited with successfully recovering 32 children nationwide. Statewide Amber Alert plans have been enacted in California, Colorado, Illinois, Indiana, Michigan, New Jersey, New York, North Carolina, and Ohio. There is pending legislation in Connecticut, Hawaii, Kentucky, Maryland, Missouri, New Hampshire, New Mexico, Oklahoma, Tennessee, Vermont, Virginia, and West Virginia. The national Amber Alert plan is pending in Congress.
Assembly Bill 322 creates a Statewide Alert System for the safe return of abducted children in Nevada. The system will be composed of a voluntary and willing partnership among State and local law enforcement agencies, radio and television broadcasters. The advocate will administer the Statewide Alert System for Missing and Exploited Children within the Office of the Attorney General. A committee is proposed to oversee the Statewide Alert System. Membership of the committee would include representatives from local law enforcement agencies, State law enforcement agencies, a representative of the Emergency Alert System (EAS), and a representative of the Nevada Broadcasters Association. The committee’s responsibility would be to set the components of a Statewide Alert System, supervise and evaluate any training necessary, monitor, review, evaluate the activations of the system, and conduct periodic tests of the system. The committee may dedicate the system to one or more persons; accept gifts, grants, and donations for use in carrying out the operations and intent of the system.
Section 10, subsection 1, on pages 3 and 4, of A.B. 322 provides broadcasters with immunity from civil liability for broadcasting descriptive information contained in a notification. The collaboration of law enforcement, Office of the Attorney General, and the broadcasters association within our State have provided the infrastructure for this system to work. In the future we will be able to work with the Nevada Department of Transportation’s reader board system on our highways and with the resorts, hotels, and casinos marquis throughout our State, thereby reaching many more people.
Chairman Rawson:
The Elizabeth Smart recovery was enabled by a citizen’s recognition and reporting.
Senator Cegavske:
Please explain the concern that initiated section 10 of the bill. Is there a national Website or does each state have its own?
Assemblyman Perkins:
The immunity proposed in section 10 is comparable to the Good Samaritan Laws in other statutes. The broadcasters are at the mercy of the information given to them. Most of the states have Websites and there is talk of a national Website. The national Amber Alert system bill will provide funding for training and other infrastructure pieces for the states that do not have that ability.
Chairman Rawson:
The impact might be lessened if the broadcasters were made to say “an alleged abduction.” If we err, we must err on the side of helping the child.
Senator Washington:
In section 9 the term jurisdiction is used, would it be the jurisdiction from which the child was abducted?
Assemblyman Perkins:
The location of the abduction does define jurisdiction. There are overlapping jurisdictions as well. The Investigation Division has jurisdiction throughout the State, whereas in my own agency it is within the borders of the city of Henderson. The agency to which the abduction is reported would be the primary agency of jurisdiction taking the report and launching the alert.
Senator Washington:
Who determines the activation of the system?
Assemblyman Perkins:
When a child is abducted, the abduction is confirmed, and then the actions listed on lines 23 through 30 occur within the law enforcement agency. Once the criterion is satisfied, the alert system is operated via a message sent from the law enforcement agency to the primary alert center that broadcasts the information. It needs to be determined whether the child is being taken outside of the Clark County area. The alerts would then expand. This system will also work on a regional basis.
Senator Washington:
Can this be accomplished within the 3-hour window?
Assemblyman Perkins:
Yes, this can occur within a short period of time. The law enforcement agencies are trained to handle these types of abductions.
Senator Neal:
In section 9, on line 23, the word “confirmed” is used. On lines 27 and 28 the term ”descriptive information” is used. You indicated that time is of the essence, but time could also be a great danger to the child, would you agree?
Assemblyman Perkins:
Certainly I would agree.
Senator Neal:
What information would be necessary to activate the system?
Assemblyman Perkins:
We need enough description of the child and the abductor so the information can be centralized to a small area. It is necessary to use a unique descriptor of the child and the abductor to narrow the calls received when the alert is given. The specific wording was included to accomplish this purpose.
Senator Neal:
Would law enforcement still have adequate discretion to make proper decisions to activate the system?
Assemblyman Perkins:
Each law enforcement agency will need to have the policies in place to participate and those policies would afford them that discretion.
Senator Neal:
Does the language on page 5, lines 24 through 26, give law enforcement the discretion to determine whether the information would endanger or help the child?
Assemblyman Perkins:
You are correct. There may be occasions when it would be more dangerous to put information out through the system. The language you are referring to applies to agencies that do not have the ability to access the alert system.
Senator Neal:
Are we referring to children less than 18 years of age?
Assemblyman Perkins:
Yes.
Senator Neal:
Is it not the policy of some police agencies to wait 48 hours before they activate an alert for a child?
Assemblyman Perkins:
Language on page 3, lines 23 through 30, are specific. Many children, ages 14 through 16, run away from home. That is not abduction.
Senator Neal:
Are you referring to deviances from a child’s customary routines or patterns?
Assemblyman Perkins:
It would take an observation of an abduction taking place or a notification of a kidnapping, and would require more details than not arriving at an appointed time.
Senator Neal:
Will this system utilize billboards on highways for distributing information?
Assemblyman Perkins:
Yes it would. With the cooperation of the Nevada Department of Transportation the reader boards on the highways would have a description. The EAS is typically on the radio and television.
Chairman Rawson:
Is there anything in the bill that would prohibit using the system for other emergencies?
Assemblyman Perkins:
The broadcasters could answer your question. They currently use the EAS for weather alerts, but it would be their authority to use the system for other emergencies. There was discussion in the Assembly concerning the age limit of 18 years or other situations. The reasoning was not to become alert fatigued. We are focusing on a specific issue. In the past, the civil alert system was in place but has since been abandoned. The Governor has created a task force to investigate the matter. Many of the procedures would not require a bill to put them in place, but it speaks to good public policy to codify this system.
Chairman Rawson:
It is the committee’s intention to process A.B. 322 upon the return of Senator Wiener.
James F. Nadeau, Lobbyist, Washoe County Sheriff’s Office:
We are in support of A.B. 322.
Gary H. Wolff, Lobbyist, Teamsters Local 14:
I am here representing the Nevada Highway Patrol and Teamsters Local 14, and am in support of this legislation.
Chairman Rawson:
Have you had successful recoveries using the Krystal Alert System?
Michelle M. Youngs, Deputy, Washoe County Sheriff’s Office:
Yes, it has been activated on three occasions and was instrumental in the recovery of Elizabeth Smart. During those activations it was within the 3-hour time frame.
Senator Neal:
What is the official name of the system?
Ms. Youngs:
Krystal and Amber are essentially the same systems. Both use the emergency broadcast system. The plan is to keep the systems uniform.
Mr. Nadeau:
The system was named the Krystal Alert System after Krystal Steadman, a child who was abducted and murdered from the Stateline, Nevada, area.
Ronald P. Dreher, Lobbyist, Peace Officers Research Association of Nevada (PORAN):
I wish to go on record as supporting this legislation and urge the committee’s support. When a system such as this is in place, it works well. Agencies, however, do not want to admit there is an abducted child. Once an agency recognizes there is an abduction, time is vital. A 3-hour time frame is too long. When the system is in place and the media is utilized, at least the child can be found. In the past, many children who had been abducted could have been found if this system had been in place.
Senator Neal:
The media is competitive. How will this be handled?
Mr. Dreher:
There has never been a problem with the media. They work uniformly and cooperatively in these types of situations. Competition is not an issue when a child is abducted.
Adrienne Abbott Gutierrez, Nevada State Chairman, Emergency Alert System:
The Amber Alert system usesthe EAS. The same system brings the public warnings of flashfloods, tornados, hazardous material spills, and anything that presents an imminent threat to life and property. This is a system that is present in every radio, television, and cable operation in the country. This is a system of the news media and the news broadcasters. Our commitment, as broadcasters is to serve our community as we are obligated to do by our license.
Senator Washington:
If the agencies and broadcasters addressed in the bill fail to comply, would they still be held immune?
Ms. Gutierrez:
These cases involve children under the age of 18. The media is always careful about broadcasting pictures and personal information about children. Broadcasting information about children under the age of 18 would make some people uncomfortable and concerned. There are situations of life and death where a picture and description is essential; therefore, broadcasters would be immune from prosecution for publicizing a child in danger.
Senator Washington:
As long as you comply with the legislation would your immunity be intact?
Ms. Gutierrez:
Yes. The information distributed in an Amber Alert is the standard information. Information goes to all broadcasters simultaneously.
Robert David Fisher, Lobbyist, Nevada Broadcasters Association:
There is national Amber Alert legislation, which we anticipate the President will sign shortly. Nevada’s Amber Alert system is different because it has been carefully crafted. In June 2001, we realized we had to strengthen the EAS. We have been working to develop the best, strongest, and most effective EAS. It is just as important for the rural areas to have functional systems as Reno.
For the record, Frankie Sue Del Papa, the Office of the Attorney General, Lorraine Hunt, the Lieutenant Governor, and the Governor have played major roles in this process. We believe everything is in place. Law enforcement Statewide, broadcasters, emergency management, and the Office of the Attorney General reviewed the draft in front of you. Starting next week there will be five training sessions throughout the State to bring law enforcement and broadcasters together and relieve your concerns.
Steve Schorn, Vice President, Cox Communications:
When I came to Las Vegas, one of the first stories I covered concerned a 10‑year-old boy who was abducted from a playground. If an Amber Alert system had been available, the child would have been found. The problem with broadcasting over the years has been the delay in getting the information out to the public. The immediacy of getting the information out is critical. I am a cofounder of Nevada Child Seekers. The need for an Amber Alert system within any community in America is critical. The EAS will help find our children immediately. If we have this system, we can save the lives of our children.
Senator Cegavske:
Do you think, because of the publicity, this system discourages abductions?
Mr. Fisher:
We decided naming the system the Amber Alert would be worth millions of dollars in protection because the term is well known. There is a dedication to Krystal Steadman. Reader boards in California are using the term “child abduction” along with Amber Alert.
Senator Washington:
Some of the large retailers have systems concerning abducted children. Would you coordinate your efforts with them to help facilitate getting the information to the public?
Ms. Gutierrez:
We are working with the casinos, paging, and cell phone companies to activate their systems with Amber Alert system information. The Malcolm Alert and Code Adam insignias on stores have different standards than the Amber Alert system. The Amber Alert system is for a confirmed abducted child, not a child missing because that child was playing with toys in another part of the store, or a child who went home with a friend instead of going home after school.
Chairman Rawson:
I will open the hearing on A.B. 70.
ASSEMBLY BILL 70 (1st Reprint): Limits certain fees which providers of health services that accept insurance payments may collect from patients. (BDR 40-33)
Assemblywoman Christina R. Giunchigliani, Assembly District No. 9:
Assembly Bill 70 is an attempt to deal with “balanced billing” which occurs periodically within the State. There are some provider contracts billing insured patients for amounts greater than the agreed upon discounted contract rate. The practice is known as “balanced billing.” Some insured patients have paid greater amounts than those specified in the contractual discounted arrangement. The bill charges exceed the contracted amounts agreed to by the provider for service. There were instances where other providers were billing patients for charges over the contracted rate. This bill is attempting to codify an improper practice and violates the Unfair Trade Practices Act. The bill would clarify that the patient is not responsible and providers cannot send bills to get money from patients.
Senator Mathews:
I received duplicate bills for my medical deductible. Would this cover a person’s deductible?
Assemblywoman Giunchigliani:
It is a good point, but I cannot answer your question.
Chairman Rawson:
We will get an answer for you. I will open the hearing on A.B. 402.
ASSEMBLY BILL 402: Revises requirements concerning approval of certain construction on behalf of health facility. (BDR 40-816)
Assemblyman Roderick (Rod) R. Sherer, Assembly District No. 36:
Assembly Bill 402 would make provisions in the Certificate of Need (CON) process. If a county of 100,000 in population and the health facility costs over $2 million the State requires a process to show the need for the health facility. The federal plan in 1971 was to curb the rising health care costs. It became effective in Nevada in 1972. In 1981, the Reagan administration recommended the phasing out of this program. There are 14 states that do not have a CON process. In 1991 Washoe and Clark Counties were exempted from the CON, and in 1995 the provision to the amount of $2 million was added for new construction.
In 1997 the first health care facility opened in Pahrump. In 2000, due to financial problems, the facility only stayed open until 6 p.m. In 2000 and 2001, Pahrump’s hospital district, a 40-bed hospital of $26 million applied for the CON process and was disapproved, but in 2001 and 2002 Banner Health Systems was approved. We in Pahrump have gone through this process before to no avail; the State awarded the CON to Banner Health Systems who withdrew their application in November 2001.
It is an hour’s drive from Pahrump to Las Vegas for health care. A short “flight for life” from Pahrump to Las Vegas costs $8000 one way. Two other companies tried for a CON to build a 25-bed hospital at the cost of $19 million. Rural Health Management Corporation was awarded the CON on July 17, 2002. This bill would help Pahrump. If this facility does not materialize, we can put this process in place. The CON is important and necessary to protect rural hospitals from losing money due to competition in the health care field. I urge the committee to vote in favor of A.B. 402.
Chairman Rawson:
Would this take care of the problem?
Assemblyman Sherer:
This bill will add a provision. If the financing is not approved, we will not need to wait another 2 years to go through the process again.
Chairman Rawson:
We are looking for a bill to put language into for Regional Emergency Medical Services (REMSA) in the Reno area and helicopter service. Would you have an objection if that were incorporated into the bill?
Assemblyman Sherer:
There would be no problem with adding that language.
Sarah Sherer:
I urge the committee to pass A.B. 402. We need a hospital in Pahrump. It takes over an hour’s drive to get medical care.
Senator Cegavske:
Do you have to travel to Las Vegas for doctor and dentists visits?
Ms. Sherer:
Yes.
Senator Cegavske:
Do you know where the hospital will be located?
Assemblyman Sherer:
It is a centrally located area.
Senator Cegavske:
How was the site acquired?
Assemblyman Sherer:
The land was donated and is being used for the down payment of the intended hospital. Financing is in place, but we need it approved. We need a letter from U.S. Senator John Ensign.
Chairman Rawson:
Is he aware the letter is needed?
Assemblyman Sherer:
His staff is aware, but the letter has not been forthcoming.
Chairman Rawson:
Our committee staff will follow through on that issue.
Lawrence P. Matheis, Lobbyist, Nevada State Medical Association:
Our position is basically what Assemblywoman Giunchigliani presented. The bill codifies what is already law. If a provider has a contract with an insurer and the contract prohibits balanced billing, it cannot be done. There are rights of actions if the bill is passed and the law is going to be codified. The problem is making certain every possible exception is mentioned. There will be confusion with regard to interpretation. The reason the bill is in its present form is because we are trying to establish under what circumstances the contract that prohibits balanced billing might not be enforced.
Since the Assembly processed the bill, there have been several cases in southern Nevada where the insurer became insolvent or bankrupt. The provider has a contract that says the provisions are still in force. Whether the provider can bill is currently handled as contract law. There were two cases in Las Vegas in the last several years, where virtually no physician was compensated for the services provided. We would propose under section 1 after “this paragraph does not prohibit a practitioner or health facility from collecting or seeking to collect from a patient,” the language, “any amount of proposed payment or reimbursement the practitioner or health facility agreed to accept from the insurer of the patient that is unpaid because of the insolvency or bankruptcy of the insurer.”
Would this make the bill moot?
Mr. Matheis:
It would not make the bill moot. We are codifying what is in contracts and contract law. All exceptions should be included to eliminate any controversy later. The issue occurs when a doctor signs a contract with your health plan or insurer and it prohibits balanced billing when you receive a service that is currently against the law. The bill would codify. If there were a contract, balanced billing cannot take place. When this is entered into the statute, every exception must be listed. If the patient has broken the rules, the insurer is not covered for a service, then the patient is responsible. If the insurer is insolvent and the service has been provided, the obligation is on the patient.
Senator Neal:
Are you for or against A.B. 70?
Mr. Matheis:
I am in favor of the bill with amendments.
Senator Neal:
When a contract is in place, is it not bad faith to receive bills?
Mr. Matheis:
If the physician, provider, or hospital has a contract with your insurer, they are held to a billing amount. If there is a violation, it should be reported to the insurance commissioner and their licensing board because it is inappropriate.
Senator Neal:
Would A.B. 70 clarify existing law?
Mr. Matheis:
If it needs to be restated in statute, then all the exceptions must be stated as well.
Chairman Rawson:
I will open the hearing on A.B. 315.
ASSEMBLY BILL 315 (1st Reprint): Requires State Health Officer or person designated by Administrator of Health Division of Department of Human Resources to analyze information reported by health facilities concerning cancer to determine trends in incidence of cancer. (BDR 40-75)
Marcia de Braga:
I will be reading from prepared testimony (Exhibit C) in favor of A.B. 315. The bill resulted from concerns about the purpose and focus of the Nevada Cancer Registry.
Senator Neal:
The 1983 law assigned the State Board of Health to do the regulation. Assembly Bill 315 is changing the reporting mechanism to the health officer. The intention in 1983 was to allow for the information to be gathered. Later, the research portion was added which changed the focus of the original provision of the statute. The intent was to find out where the clusters were and find a means to eliminate them.
Mrs. de Braga:
I have spoken to the person who started the first cancer registry. The data was analyzed but became overwhelming and there was no funding to continue.
Jeff Braccini:
I am reading from prepared testimony (Exhibit D) relating my experience as the father of a son with lymphocytic leukemia. On page 2 (Exhibit D) there is a statement from Dr. Michael Harbut, M.D., M.P.H., FCCP Chief, and Center for Occupational/Environmental Medicine.
Chairman Rawson:
Has the spread of radioactive substances been ruled out?
Mrs. de Braga:
It has been eliminated, but testing around the site continues. There is a possibility of water contamination in Fallon.
Chairman Rawson:
Was the testing done on deep underground bedrock?
Mrs. de Braga:
Yes.
Chairman Rawson:
Have they found any radioactive substances in the water?
Mrs. de Braga:
Ten years ago, wells in specific areas were tested. High concentrations of radionuclides and radioactive material were found on the east side of Fallon. The Health Division never took any action on those findings. The tests were renewed and conditions did not change.
Chairman Rawson:
Has the cluster come from the east side of Fallon?
Mrs. de Braga:
Not on the east side of Fallon. They are private wells, not city water.
Senator Cegavske:
Have any of the mysteries been solved in other states? How long has it taken to discover the cause?
Mrs. de Braga:
Yes, in Massachusetts the problem was solvents used in the tanning of leather. There is something similar occurring north of that area. It was in the water.
Senator Cegavske:
How did the solvents get into the water system?
Mrs. de Braga:
It was dumped into the water system.
Senator Cegavske:
Is there industrial dumping in Fallon?
Mrs. de Braga:
There is not much. A Centers for Disease Control and Prevention (CDC) member told us not to wait until science catches up. Take action now. There was an old freight yard where the city stored contaminants. There was an underground nuclear explosion, aerial crop spraying, mosquito spraying, and fuel lines running from California to the Navy base in Fallon encompassing the city. The CDC required the fuel lines to be tested for leakage, which was done by the company even though they had caused problems in another California community because of a leaking pipeline. There are military flights over Fallon using jet fuel. All are possibilities and when coupled with ultra violet rays, cigarette smoke, and tungsten could be the cause of our problem. Fallon has many contaminants.
Senator Cegavske:
How long did it take Massachusetts to clean up the problem?
Mrs. de Braga:
It took them a few years.
Senator Neal:
Where are the clusters occurring?
Mrs. de Braga:
The majority was either on the west side of Fallon or the northwest side. There are some in town as well. There is no clear, exact pattern except the majority is in a flight pattern or where the fuel line is located. In the northwest part of the county there are private wells with a high level of arsenic.
Senator Neal:
Is there any evidence of carcinogens in the cattle?
Mrs. de Braga:
I am not aware of testing cattle, but other animals have been tested. There was an area where fuel was dumped and cattle were scalded. The practice was stopped once the veterinarians brought it to the attention of the military.
Senator Neal:
In the 1970s there was an issue concerning arsenic and water in Fallon. My knowledge is that arsenic is a poison. This issue became a heated debate and nothing was done about the problem at that time.
Mrs. de Braga:
It has been a known fact the water in Fallon has needed to be cleaned up for over 40 years. Fallon has a high rate of cancer in all forms.
Chairman Rawson:
It is important not to make unfounded decisions. The purpose for the bill is to study the problem and find a result.
Mrs. de Braga:
The pipeline is tested regularly.
For the record, there is a letter from Matthew Warneke (Exhibit E) and Floyd B. Sands (Exhibit F) supporting A.B. 315. They also suggest reporting to the registry be made easier and without fees, making reporting faster and more convenient.
Senator Nolan:
What are the requirements and time frames for reporting to the registry?
Mrs. de Braga:
It is 6 months based on the bill passed last session. It requires the State health officer to establish and maintain a system of reporting information, which must include the conducting of comprehensive epidemiological surveys of cancer and cancer-related diseases. The State board will prescribe the form and manner in which the data will be reported. The reports must include name, address, pathological findings, stage of disease, environmental and occupational factors, method of treatment, incidents of disease in the family, and where the residents have lived.
Senator Nolan:
Does the requirement for reporting the cancer fall on the physician?
Mrs. de Braga:
Physicians, hospitals, medical labs, diagnosticians, and facilities providing screening and therapeutic services do reporting. Reports will be published. There are regulations protecting the patient’s identity.
Senator Neal:
The original bill made it mandatory for the doctors, hospitals, and health facilities to report the diagnosed cancer to the State Board of Health.
Senator Nolan:
Are we comfortable this subject is broadly disseminated? I am concerned whether physicians are aware of this requirement.
Chairman Rawson:
We are doing abstracting now. We are catching cases being treated in Nevada.
Mrs. de Braga:
We became aware of the number of cases because some treatments could be received in Fallon.
Chairman Rawson:
Fallon is a small area whereas in Las Vegas only your neighbors would know.
Mrs. de Braga:
After this problem received media attention, persons who had moved from the Fallon area notified us.
Assemblywoman Ellen Marie Koivisto, Clark County Assembly District No. 14:
One of the facts we learned through the hearings was the information that is assembled takes 2 years before it is put into the registry.
Buffy Gail Martin, Lobbyist, American Cancer Society/Reno:
According to the American Cancer Society, in 2003 we can expect 10,300 new cases of cancer in Nevada. About 4300 Nevadans will die from cancer this year. Identifying trends in the rate of cancer incidence relating to geography or population is vital to helping the fight against cancer.
Assembly Bill 315 would create the necessary link to analyze possible cancer trends, and would establish interdepartmental action that could control and consequently prevent any further rates of incidence of cancer affecting a particular area or population.
Analysis, research, and education could be tools that help our State stem the rising cases of cancer and cancer-related deaths. The American Cancer Society and our volunteers urge your support of A.B. 315.
Senator Wiener:
I have discovered many people I grew up with in the Las Vegas have thyroid cancer. Have you found a prominence of thyroid cancer in southern Nevada?
Ms. Martin:
Clark County has the highest rate of incidents of thyroid cancer in the country. There is a direct link to the above-ground testing to various cancers.
Chairman Rawson:
I will hear further testimony on A.B. 402.
Roy Barraclough, Project Development Officer, Rural Health Management Corporation, and Rural Health Services of Nevada, Incorporated:
I am reading from prepared testimony (Exhibit G) concerning A.B. 402 and I support the CON law.
Chairman Rawson:
Assembly Bill 402 has been introduced to help Pahrump gain medical services. This body has no intention of eliminating CON. Can you shed light on the situation in Pahrump?
Mr. Barraclough:
There are no acute-care services in Pahrump. Until recently there was an urgent care facility, but because of numerous problems, the facility closed.
Chairman Rawson:
Can a hospital be viable in Pahrump?
Mr. Barraclough:
Yes. Based on the population, the appropriate design, and licensing as a critical‑access facility our projections are that a hospital will grow with the community and provide sufficient resources for expansion.
Senator Washington:
Would the facility be a “not-for-profit” hospital?
Mr. Barraclough:
Yes, it is a “not-for-profit” organization.
Senator Washington:
The nearest trauma center is a 45-minute drive from Pahrump?
Mr. Barraclough:
It would be to the nearest facility, which is in Las Vegas.
Senator Washington:
There is no acute-care facility in Pahrump?
Mr. Barraclough:
There is none. This is an area of 30,000 plus population.
Chairman Rawson:
Mesquite in Clark County would qualify, but there is a hospital started.
Mr. Barraclough:
Mesquite did not have to go through the CON process because of their location in Clark County.
Robin L. Keith, Lobbyist, Nevada Rural Hospital Partners Foundation:
We concur with the testimony on A.B. 402. We urge the retention of the CON process for Nevada’s rural hospitals. We understand the problems Pahrump is facing by bringing a hospital to their area and hope A.B. 402 will assist them in their efforts.
Chairman Rawson:
Is there a conflict if we would institute a CON process for helicopter service in Washoe County?
Ms. Keith:
In view of recent discussions about other specialty services we are aware of, making services is unviable.
Senator Neal:
Why is it necessary to have a CON process for Pahrump?
Chairman Rawson:
It is part of Nye County and Tonopah has a hospital.
Senator Neal:
To drive from Pahrump to Tonopah is 130 to 140 miles.
Chairman Rawson:
It is still in the county.
Senator Neal:
Would anyone go to a hospital in Tonopah from Pahrump?
Chairman Rawson:
This is the reason for A.B. 402.
Mr. Barraclough:
We are concerned about the continuation of the CON coverage for the new hospital because we want to optimize the potential of the hospital becoming financially viable as quickly as possible. Pahrump’s proximity to Las Vegas is the issue. It is a 45-minute, 55- to 60-mile drive. There are specialists in Las Vegas who would like to “cherry pick” the Pahrump community.
Mary G. Griffith, R.N., Health Research Analyst, Health Division, Department of Human Resources:
Assembly Bill 402 allows exclusion to the provision of chapter 430 of Nevada Revised Statutes, which requires the director of human resources to approve the new construction of a health facility. Currently, the construction of new health facilities at a cost of over $2,000,000 in counties in Nevada where the population is less than 100,000 requires a letter of approval from the director of the Department of Human Resources. This process is known as a CON. The proposed new construction, which requires a CON review, must submit an application that justifies the need for the project. The criterion is whether a need for the proposed project exists in the community, the proposed project is feasible, the effect of the project on the cost of health care, and the appropriateness of the proposed project for the community. The department conducts a public hearing to document public comment in the community.
SENATOR CEGAVSKE MOVED TO DO PASS A.B. 322.
SENATOR NEAL SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY.
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Chairman Rawson:
We will check with legal to see whether our titles match. If appropriate, CON would be inserted for REMSA in Reno.
SENATOR CEGAVSKE MOVED TO AMEND AND DO PASS A.B. 402.
SENATOR MATHEWS SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY.
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Chairman Rawson:
I am going to ask our State health officer to report to us on A.B. 315. There is no fiscal note because it is in practice. We will put it in our next work session. There is a suggested amendment to A.B. 70; therefore, it will be included in a work session. There being no further business before us today, I will adjourn this meeting at 4:11 p.m.
RESPECTFULLY SUBMITTED:
Patricia Vardakis,
Committee Secretary
APPROVED BY:
Senator Raymond D. Rawson, Chairman
DATE: