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From YouTube: 4/26/2021 - Assembly Committee on Commerce and Labor
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A
C
E
A
How
to
eat
present?
Mr
secretary,
please
note
that
speaker,
fryerson
is
also
present.
Please
mark
other
members,
absent,
excuse
and
mark
them
present
when
they
arrive.
They
have
given
me
notice
that
they
are
presenting
in
another
committee
at
this
time,
welcome
to
our
audience
tuning
in
over
the
internet.
Before
we
start,
I
would
like
to
go
over
some
quick
housekeeping
announcements.
Please
remember
all
exhibits,
written
testimony
and
amendments
must
be
submitted
by
noon.
A
On
the
business
day
prior
to
the
committee
meeting
persons
wishing
to
test
provide
testimony
or
attend
the
meeting
virtually
must
pre-register
online
at
the
legislature's
website.
The
public
is
strongly
encouraged
to
submit
written
testimony
in
advance
of
the
meeting
by
emailing
the
assembly
committee
on
commerce
and
labor
members
and
presenters
and
people
here
in
the
audience.
Please
remember
to
keep
your
camera
on
at
all
times.
This
will
help
us
ensure
we
have
a
quorum
at
all
times.
Unless
you
are
I'm
sorry,
I
was
reading
my
zoom
in
housekeeping.
A
Still
we're
no
longer
in
zoom,
so
don't
mind
that,
but
please
remember
to
silence
all
electronics,
members
and
presenters
who
are
on
zoom.
Please
keep
your
cameras
on
so
that
we
can
see
you
on
the
screen.
Thank
you.
Everyone
and,
let's
begin
with
our
first
agenda
item.
We
have
three
bills
up
for
hearing
today.
I
will
be
taking
them
out
of
order.
A
G
G
I
am
very
excited
to
be
with
you
here
today
to
present
senate
bill
229,
which
is
all
about
access
to
health
care,
and
I
just
want
to
express
my
gratitude
to
the
committee
for
allowing
us
to
go
first,
because
my
co-presenter
is
dr
beth
slamowicz,
who,
with
the
department
of
health,
insur
health
and
human
services,
heads
up
all
of
their
pharmaceutical
work.
She
is
significantly
and
incredibly
smarter
than
I
am,
and
we
really
do
need
the
benefit
of
her
in
the
committee
and
she
is
presenting
helping
to
present
in
another
committee.
G
So,
first
of
all,
I
wanted
to
just
say
that
sb
229
is
about
access
to
health
care,
for
many
of
us
have
been
working
for
many
sessions
to
make
sure
that
we
are
using
all
types
of
practitioners,
all
types
of
types
of
health
professionals
to
the
top
of
their
scope
of
practice,
because
we
know
that,
for
the
state
of
nevada,
almost
every
portion
of
the
state
is
a
health
provider
shortage
area,
and
we
cannot
afford
to
not
use
all
of
our
health
professionals
to
the
best
of
their
ability.
G
G
What
I'm
happy
to
report
with
only
five
weeks
left
in
the
session
is.
This
is
not
a
scope
of
practice
bill.
There
is
no
fight
here
about
scope
of
practice
and
explicitly
in
the
bill.
It
says
that
a
collaborative
agreement
does
not
allow.
It
specifically
prohibits
a
pharmacist
from
working
outside
of
scope
of
practice.
So
that's
not
what
this
is
about.
G
What
this
is
about
is
that
during
the
pandemic,
we
learned
the
hard
way
that
the
way
that
we
have
collaborative
practice
agreements
set
up
in
nrs
in
nevada
puts
significant
barriers
in
place
for
those
collaborative
practice
agreements
to
be
implemented
and
to
be
effective.
The
pandemic
brought
to
light
in,
unfortunately,
not
such
great
ways.
G
So
what
this
bill
does
is
it
makes
a
series
of
tweaks
to
collaborative
practice
agreements
so
that
they
can
be
used
going
forward
and
that
it
would
not
require
an
emergency
declaration
to
do
so
as
a
couple
of
examples
in
the
in
the
law
as
it
was
currently
written,
it
always
had
to
happen
in
a
medical
facility.
G
It
does
not
necessarily
always
need
to
happen
in
a
medical
facility
and
again,
I
think
the
pandemic
has
shown
shown
a
light
on
there's.
There
are
situations
where
it's
completely
appropriate
for
things
to
not
happen
in
a
medical
facility,
so
that's
just
one
example
of
the
barriers
that
we
are
removing
to
collaborative
practice
so
again
staying
at
the
highest
level.
G
This
is
not
a
scope
of
practice
bill.
The
pharmacist's
scope
of
practice
remains
exactly
the
same.
It
is
a
bill
which
strengthens
our
collaborative
practice
agreement
framework
and
just
to
give
you
another
example.
So
we've
talked
about
the
heart
specialist
who
would
be
working
perhaps
with
a
pharmacist
who's
right
there
in
their
practice.
Let's
talk
about
a
different
example,
and
that
would
be
flu
so
right
now
we
have
a
readily
available
lab
test
where,
if
you
can
get
to
that
lab
test,
you
can
you
can
take
that
test.
G
G
So,
for
example,
a
collaborative
practice
agreement
could
be
set
up
where
a
physician
working
with
a
pharmacist
could
say
under
these
protocols.
I
give
you
permission
to,
or
I
not
permission
but
with
we.
We
agree
within
this
collaborative
practice
agreement
that
under
these
protocols,
you
can
give
this
test
look
at
this
test
and
distribute
this
pharmaceutical,
and
that
would
then
bring
down
the
incidence
of
flu
because
on
a
public
health
before
before
covet
19,
you
may
all
remember
that
the
spread
of
flu
was
one
of
our
most
significant
public
health.
G
We
do
these
huge
vaccination
campaigns
all
these
things.
If
we
can
stop
flu
sooner
with
more
people,
then
we
stop
the
spread
and
as
a
from
an
access
to
health
care
issue,
a
lot
of
folks
just
would
never
get
into
the
doctor
right.
They
definitely
are
not
going
to
get
into
the
doctor
within
48
hours
to
get
that
sort
of
a
issue.
G
So
that's
the
idea
can
be
used
in
a
wide
variety
of
settings,
and
so
the
law
was
so
prescriptive
that
it
did
not
allow
for
that
variety
of
settings
to
be
facilitated,
and
so
what
this
bill
does.
Is
it
walks
back
some
of
the
prescriptive
nature
of
nrs
and
allows
for
that
to
be
in
the
specific
practice
agreement
instead
that
that
practitioner
and
that
pharmacist
would
sign
off
on
there's
still
a
very
strong
framework
with
some
guidelines,
just
not
the
same
level
of
detail.
G
H
Thank
you
senator
roddy,
and
thank
you
chairman
and
committee,
for
the
record.
My
name
is
beth
slamwitz.
I
am
the
senior
policy
advisor
on
pharmacy
for
the
department
of
health
and
human
services,
I'm
going
to
give
kind
of
a
brief
overview
of
collaborative
practice
agreements
and
senate
bill
229
and
then
go
into
the
different
sections
of
the
bill
and
what
they
address
in
terms
of
amended
language
for
collaborative
practice,
agreements
collaborative
practice
agreements
create
a
formal
practice,
relationship
between
pharmacists
and
other
health
care
providers,
whereby
the
pharmacist
assumes
responsibility
for
specific
patient
care
functions.
H
The
extent
of
the
services
authorized
under
the
collaborative
practice
agreement
depends
on
the
state,
statutory
and
regulatory
provisions
for
that
authority,
as
well
as
the
terms
of
the
specific
agreement
between
the
pharmacist
and
the
healthcare
practitioner
in
their
2015
paper.
The
expanding
role
of
pharmacists
in
a
transformed
health
care
system,
the
national
governors
association
presented
the
following
state
policy
considerations
in
regards
to
collaborative
practice
provisions
one
was
to
enact
broad
collaborative
practice,
provisions
that
allow
for
specific
provider
functions
to
be
determined
at
the
provider
level
rather
than
set
in
statute
or
through
regulation.
H
H
H
Subsection
2
or
section
2,
subsection
3
amends
adds
amended
language
to
include
that
a
practitioner
shall
not
enter
into
a
collaborative
practice
agreement
with
a
pharmacist
if
the
geographic
distance
between
the
collaborators
prevents
or
limits
effective
collaboration
in
delivery
of
care
or
treatment
of
the
patients,
subsection
4
adds
amended
language
that
a
practitioner
shall
not
enter
into
the
agreement.
That
includes
a
diagnosis
or
initiating
of
treatment.
H
Unless
that
practitioner
actively
practices
his
or
her
profession
in
the
state
or
provides
those
services
using
telehealth,
the
board
also
may
grant
a
written
request
for
exemption
from
the
requirements
of
this
subsection.
If
good
cause
is
shown,
subsection
5
adds
language
that
a
collaborative
practice
agreement
does
not
grant
a
pharmacist
the
authority
to
gain
engage
in
any
activity
that
is
outside
the
scope
of
practice
of
the
collaborating
practitioner.
H
Lastly,
the
requirement
that
a
practitioner
may
not
enter
into
a
collaborative
practice
agreement
with
a
pharmacist
for
the
management
of
controlled
substances
is
removed.
It
is
recommended
that
all
prescription
drugs,
including
control
substances,
may
be
included
within
a
pharmacist's
collaborative
practice
authority.
H
These
include
a
description
of
the
types
of
decisions
concerning
the
management
of
drug
therapy,
a
detailed
explanation
of
the
procedures
that
the
pharmacist
must
follow,
including
documentation
and
a
requirement
to
report
such
decisions
to
the
practitioner
and
receive
feedback.
The
procedure
by
which
a
pharmacist
will
notify
the
practitioner
of
an
adverse
event.
H
H
H
A
description
of
the
types
of
decisions
that
a
pharmacist
can
make
regarding
the
management
of
drug
therapy,
including
description
of
diseases,
drugs
or
drug
classes,
should
to
be
covered
within
the
protocol.
The
types
of
decisions
that
the
pharmacist
can
make
regarding
those
diseases,
drugs
or
drug
classes,
the
training
the
pharmacist
is
required
to
complete
the
procedures.
H
H
G
Thank
you,
dr
slamowicz,
and
then
I
would
just
close
senator
raddy
again
for
the
record.
That
is
the
end
of
our
formal
presentation,
but
just
so
you're,
aware
of
who
you
have
available
in
terms
of
answering
questions,
and
we
do
have
adam
porath,
who
is
a
pharmacist
in
a
hospital
setting
to
be
who
is
actually
a
practitioner
and
can
give
you
a
little
bit
more
of
the
on
the
ground
sense
of
it.
G
We
also
have
representation
from
the
board
of
pharmacy
and
representation
from
the
retail
retailers
association
that
represents
the
more
retail
pharmacy
setting,
so
that
you
sort
of
the
scope
of
folks
who
might
be
implementing
this
type
of
a
collaborative
practice
agreement
to
help
answer
questions.
Thank
you,
madam
chair,
for
the
opportunity
we
stand
ready
to
answer
questions.
Thank
you.
A
I
And
thank
you,
madam
chair
nfma.
I
have
two
so
it
went
by
pretty
quick
but
with
the
distance
as
far
as
the
collaboration
goes,
if
you
could
repeat
that
portion,
there's
something
about
having
to
be
within
a
certain
distance
in
order
to
make
it
work
so.
G
If
you
go
to
the
heart
specialist
example
and
you're
a
person
in
a
rural
community
with
a
rare
heart
condition,
you
may
not
have
that
heart
specialist
within
100
miles,
but
that
heart
specialist
could
still
enter
into
a
collaborative
practice
agreement
with
somebody
in
your
community,
a
pharmacist
in
your
community
to
get
you
better
access
to
care
the
way
the
law
is
currently
written.
That
100
miles
would
be
prohibitive
to
that
arrangement.
G
So
now
the
law
says
it
is.
It
says
that
it
has
to
be
within
a
distance
that
does
not
interfere
with
a
good
collaborative
working
agreement
and
that
would
be
distinct
depending
on
what
kind
of
collaborative
agreement
was
entered
into
and
dr
slamwitch,
if
you
can
help
me
with
the
page
number
that
would
I'd
appreciate
it.
G
So
that's
the
shift
taking
out
a
hundred
miles
as
a
very
specific
thing
and
adding
if
the
geographic
distance
between
the
practitioner
and
the
collaborating
pharmacist
prevents
or
limits
effective
collaboration
and
the
delivery
of
care
of
treatments
to
patients.
H
I
think
probably
adam
horath
probably
has
more
history
with
this
than
I
do.
As
I
know
he's
been
involved
in
all
of
this.
I
do
think
that
there
was
original
and
then
there
was
some
additional
language
in
2017,
but
I
know
adam
has
more
detail
than
I
do.
F
Yeah,
thank
you
for
the
record.
Adam
porter,
I'm
the
vice
president
of
pharmacy,
here
at
renowned
health
collaborative
practice
in
the
state
of
nevada,
really
started
back
in
2011,
and
that
was
the
first
time
that
we
saw
pharmacists
practicing
what
we
called
affiliated
practice
settings
with
health
systems.
So
for
my
particular
example,
that's
when
we
started
to
do
this
work
at
our
firmly
facility,
rather
than
just
in
the
four
walls
of
the
hospital
here.
I
Okay,
thank
you,
you're
correct,
and
I
thought
so
and
I
I
do
remember
some
of
the
conversations
and
it
was
really
centered
around
medical
facilities
in
order
to
let
the
doctor
and
the
pharmacist
at
that
facility
take
care
of
patients
at
that
facility,
since
they
were
working
with
the
same
same
population.
I
G
Thank
you
for
the
question:
julia
ratty
for
the
record
through
you
assemblywoman.
How
do
you
two
assemblywoman?
You
can.
G
To
the
member
senator,
thank
you.
I
appreciate
it.
So
it's
a
great
question
and
certainly
in
the
senate,
it
was
the
longest
conversation
that
we
had
was
about
consent.
G
I
consider
this
to
be
a
modernization
of
the
language,
as
the
medical
system
has
become
more
comfortable
with
a
variety
of
practitioners,
whether
that
be
an
aprn
or
a
pa,
or
any
number
of
others
that
we've
worked
on.
We've
moved
away
from
that
consent,
piece
and
more
towards
badges
and
things
that
just
label
who
they
are
this
consent.
Then,
if
you
think
about
the
flu
example
that
that
consent
may
not
be
as
necessary,
because
it's
a
very
straightforward
transaction,
more
of
a
transactional
piece,
here's
here's
my
sample,
here's
your
test!
G
F
Yeah
for
the
record,
adam
port,
as
is
in
current
nevada
law,
and
would
be
maintained
in
this
anytime-
that
a
pharmacist
makes
a
a
change
in
a
patient's
medication.
They're
required
to
provide
that
documentation
to
the
patient
any
time
that
a
pharmacist
performs
a
test
on
the
patient.
They
are
it's
it's
required
that
they
provide
the
results
of
the
test
to
the
patient.
F
I
I
I
I
just
think
we
need
to
make
sure
that
the
patient
we've
done
everything
in
this
building
over
years
and
years
and
years
to
make
sure
that
things
are
patient-centric
and
it,
and
I
just
want
to
make
sure
in
this
collaborative
agreement
that
we're
not
making
decisions
for
the
patient,
but
not
keeping
them
informed
of
what's
going
on
and
making
sure
that
they
have
the
opportunity
to
ask
that
question
of
well.
Why
would
you
have
changed
this
to
understand
what
their
own
medical
care
is?
How
would
that
work.
H
Yeah
sure
so
best
timelines
again
for
the
record.
So
I
think
what
might
be
helpful
is
to
kind
of
understand
how
these
agreements
work
in
a
in
a
clinical
setting
and
adam
may
be
able
to
kind
of
walk
you
through
what
it
may
what
it
is
like
for
a
patient
who
sees
a
pharmacist,
it's
no
different
than
if
they
were
seeing
a
physician
or
they
were
seeing
a
nurse
practitioner
or
they
were
seeing
a
pa.
H
Whether
if
that
patient
happens
to
be
diabetic
and
the
pharmacist
is
going
to
be,
you
know,
checking
blood
samples
to
make
sure
that
their
hemoglobin
their
a1c
is
in
check
where
their
levels,
I'm
seeing
them
on
a
regular
basis
to
say:
okay,
based
on
how
your
labs
came
back,
we're
going
to
make
adjustments
to
the
medication
that
doesn't
break
or
take
away
that
relationship
that
that
patient
has
with
their
physician
if
they
aren't
happy
with
the
care
that
they're
receiving
or
they
have
questions
about
their
medication.
H
You
know.
Certainly
pharmacists
are
medication
experts.
So
I
would
hope
that
that
patient
has
that
conversation
with
the
pharmacist
first.
If
they
don't
get
those
answers
that
they're
seeking
they
can
certainly
go
back
to
their
physician,
it's
meant
to
be
collaborative,
as
it
says
in
its
title,
so
you
know.
The
hope
is
that
the
practitioner
and
the
pharmacist
and
the
patient
is
all
working
collaboratively
for
the
greater
good
of
that
patient's
care
and,
ultimately
making
sure
that
you
know
their
health
and
their
wants
and
their
needs
are
taken
into
consideration.
H
I
I
G
H
G
So
senator
ready
for
the
record,
I
would
not
present
that
bill,
so
the
there's
there's
no
mandate
that
they
continue
to
see
that
pharmacist,
there's
no
mandate
that
they
don't
have
an
appointment
with
their
doctor.
So
I
just
want
to
make
sure
that
that,
for
the
record
is
very
clear,
this.
I
G
J
J
G
Absolutely
so
senator
ready
for
the
record
and
again
we'll
turn
it
back
over
to
the
experts,
but
just
generally
think
of
cancer
drugs
so
or
think
of
a
patient
who's
going
through
a
cancer
diagnosis
that
has
significant
pain
management.
G
That's
not
working
kind
of
move
through
that
process
with
that
patient
under
that
collaborative
practice
agreement
with
those
protocols.
So
that
is
an
example.
I
will
just
be
very
explicit.
There
is
nothing
in
this
bill
that
removes
any
of
the
protections
reporting
requirements,
all
the
logging
of
information
that
we
have
been
working
on
very
heavily
over
the
last
multiple
sessions
on
pain,
management
and
pain,
medications,
those
all
still
stand,
and
that
work
all
still
needs
to
be
done.
G
G
H
Thank
you,
senator
robbie,
beth
slamwitz
for
the
record
again
so
just
to
follow
up
with
what
senator
rowdy
said.
When
I
was
a
student,
I
actually
worked
in
a
collaborative
arrangement
with
a
physician
at
a
outpatient
chemotherapy
clinic
and
did
assist
in
the
management
of
patients,
not
only
their
pain
medications,
but
also
their
anti-nausea
medications,
as
well
as
medications
for
constipation.
H
That
is
often
caused
with
the
use
of
pain
medications,
and
so
that
is
a
really
good
example
of
where
control
substances
would
come
in
and
then
just
from
a
broader
standpoint.
Yes,
pain.
Medicines
are
the
very
first
thing,
opioids
or
narcotics
is
what
people
think
of
when
they
think
of
control
substances.
H
But
there
are
many
other
medications
that
fall
under
the
category
of
the
control
substances.
Some
of
those
might
be
for
the
treatment
of
substance
use
disorders,
although
they
can
be
sometimes
used
to
treat
pain.
They
are
also
used
to
combat
the
addiction
to
opioids
or
the
addiction
to
alcohol
and
other
items
where
it
may
be
beneficial
to
have
an
agreement
between
a
physician
and
a
pharmacist
to
help
assist
those
types
of
patients.
H
And
then
there
are,
you
know,
other
medications
that
fall
into
other
categories.
Besides
just
what
we
consider
to
be
a
control,
control-2
substance,
things
like
benzodiazepines
that
treat
you
know,
anxiety
or
different
psychiatric
diagnoses
and
so
control
substances
can
be
a
very
lo,
a
broad
class
of
medications
not
just
for
pain.
A
Okay,
senator
I
do
have
one.
It
was
in
the
areas
where
we
were
deleting
some
of
the
language
and
specifically
the
language
that
deleted
the
approval
of
the
board
of
pharmacy
for
the
agreements,
and
I
just
just
wanted
to
see
if
you
could
just
address
why
we
were
removing
the
requirement
that
the
agreements
have
to
be
approved
by
the
board.
G
K
I'm
dave,
we
see
exec
dave,
wiese,
executive
secretary
of
the
board
of
pharmacy
for
the
record
that
that
was
seen
as
could
be
too
restrictive.
If
we
get
some
of
these
moving,
and
so
we
currently
do
it's
a
policy
decision
by
the
legislature.
The
board
is
supportive
of
us
not
reviewing
them,
we'll
review
them
if
you
want
us
to,
but
I
think
we
can
trust
the
pharmacist
and
the
physicians
to
work
on
the
agreements.
K
I
I
think
that
there's
I
mean
it
takes
a
review,
so
under
the
new
rule
they
could
just
start
implementing
them.
For
us,
we
would
have
to
review
them
and
there's
a
lot
of
work
goes
into
it,
making
sure
the
guidelines
are
exactly
what
they're
doing
so
there
there's
some
delay
in
getting
them
approved.
Yes,.
A
Okay-
and
that
was
dave
west
for
the
record.
G
Chair,
if
I
may
senator
reddy
for
the
record,
the
current
language
in
nrs
is
quite
restrictive,
and
so
what
we
haven't.
We
just
haven't
seen
a
significant
number
of
collaborative
practice
agreements.
B
Thank
you
chair,
I'm
not
sure
who
can
answer
this,
I'm
sort
of
going
along
with
miss
carlton's
questioning
what
I
want
to,
because
it
is
somewhat
new.
I
want
to
make
sure
that
the
patient
is
aware
in
this
procedure
that,
if
a
drug
treatment
or
drug
is
changed
even
when
it
goes
from
a
to
generic
drug
for
cost,
that
the
patient
is
aware
of
who
made
the
change.
That's
what
I
read
in
here
and
that
they
understand
it's
a
pharmacist,
who's,
not
a
doctor,
and
then
in
building
upon
that.
G
G
G
So
for
that
broad
range
of
examples
of
how
a
collaborative
practice
agreement
could
be
used,
what
the
bill
calls
for
is
that
in
the
confines
of
that
collaborative
practice,
agreement
that
would
be
detailed
out
and
so
for
the
heart
practice.
The
heart
doctor
could
say
to
the
pharmacist.
You
know
this.
This
is
how
we,
in
our
practice,
inform
our
patients
right
and,
and
that
is
built
into
the
model
versus
the
retail
pharmacy,
setting
where
it's
just
a
flu
piece
and
there's
really
not
a
whole
lot
there,
except
for
here's.
G
Your
antiviral
and
folks
are
happy
to
take
that
and
be
on
their
way.
So,
rather
than
being
explicit
in
nrs,
it's
explicit
in
the
collaborative
practice
agreement
of
how
that
practitioner
is
working
with
that
pharmacist
to
make
sure
that
that
patient
is
taken
care
of,
if
that's,
not
sufficient
enough,
I'm
happy
to
take
another
another
crack
at
this.
I
will
say
that
we
worked
pretty
extensively
with
the
ods
and
the
mds
on
the
first
version
of
the
bill
to
get
to
a
place
where
we
had
removed
their
concerns.
B
I
think
that
if
I
may
ask
one
follow-up,
so
I
understand
on
those
serious
issues,
as
you
were
saying:
the
heart
treatment,
how
about
I'm
under
some,
possibly
under
some
treatment
and
the
doctor
has
prescribed
various
medication.
I
deal
with
a
local
pharmacy
who
has
multiple
pharmacists
in
there.
Would
that
also?
G
So,
thank
you
for
the
question.
Julia
ready
for
the
record.
That
is
probably
not
an
ideal
situation
for
a
collaborative
practice
agreement
and
you
wouldn't
see
one,
but
I
mean
that
just
not
the
nature
of
how
a
collaborative
practice
agreement
works.
This
is
not
the
the
short-term
medication
for
this
piece
of
this.
You
know
this
thing
that
you're
working
on
right
now
it
kind
of
lives
at
both
ends
of
the
spectrum.
If
you
will.
B
J
H
Sure
absolutely
thank
you.
Senator
reddy,
so
beth
somewhat
for
the
record
collaborative
practice.
Agreements
are
definitely
not
new.
As
dr
porath
mentioned
earlier,
in
nevada,
we've
been
working
on
this
since
2011..
H
Several
other
states
already
have
collaborative
practice.
Arrangements
in
place.
Nevada
has
some
of
the
most
restrictive
requirements,
but
there
are
other
states.
So
collaborative
practice
authority
exists
in
idaho,
illinois,
minnesota,
michigan
montana,
nebraska,
new
mexico,
north
dakota,
south
dakota,
tennessee,
utah
vermont,
just
to
name
a
few.
H
J
G
Julia
ready
for
the
record,
I
see
them
all
nodding,
but
that
won't
translate
well
to
the
minute.
So,
yes,
the
answer
is
yes.
What
what
we
have
learned
over
since
2011
is
that
our
our
law
was
written,
particularly
restrictive
in
nature,
and
then
that
was
amplified
in
a
pretty
dramatic
way,
with
the
pandemic,
where
we
were
not
able
to
quickly
put
our
pharmacists
to
work
again
well
within
their
scope
of
practice.
G
D
G
Process
along
a
little
bit
more
quickly
for
patients
in
a
way
that
is
completely
appropriate
completely
within
the
scope
of
practice.
But
right
now
our
just
the
little
piece
about
having
to
be
in
a
medical
facility
would
prohibit
something
like
that
from
happening.
So
that's
what
this
bill
seeks
to
do
is
remove
those
restrictions.
A
E
Good
afternoon,
madam
chair
and
members
of
the
committee,
thank
you
for
allowing
me
to
support
and
thank
you
for
bringing
this
bill
forward.
Senator
ratty
and
minnie,
and
the
coalition
have
worked
together
to
try
to
make
this
bill
where
it
has.
It
has
feed
where
it
will
actually
do
something.
In
2017,
as
islamic
woman
carlton
mentioned,
sb290
passed
and.
E
It
was
so
very
restrictive,
as
mentioned
before,
that
we're
coming
before
you
now
to
talk
about
how
the
pharmacist
can
be
a
provider
here
there
there
are
many
times
that
a
pharmacist
is
the
first
line
of
health
care
for
people
I'm
very
blessed
right
now,
as
many
of
us
are
that
I
have
health
insurance.
There
was
a
time
in
my
life
that
I
did
not
have
health
insurance
and
I
did
use
my
pharmacist.
I
utilized
a
pharmacist
that
worked
next
door
to
me
and
they
were
my
health
care
provider.
E
Many
of
the
conditions
such
as
asthma,
chronic
obstructive
pulmonary
disease,
hypertension,
hyperlipidemia,
diabetes,
congestive,
heart
failure
and
other
health
conditions
in
other
states.
Pharmacists
are
successfully
able
to
help
and
treat
the
medication.
Do
medication,
management
for
these
patients
and,
as
stated
the
current
pandemic,
again
showed
us
how
nevada
has
a
real
lack
of
health
care
providers
and
the
pharmacist
can
fill
that
void.
Pharmacists
are
highly
trained.
Their
training
includes
a
four-year
doctoral
level
degree
with
extensive
core
coursework
in
pharmacology
and
pharmacolog
other
pharmacological
areas.
E
They
have
an
unbelievable
ability
to
manage
your
medication,
where
most
other
prescribers
have
very
limited
knowledge
of
pharmacology,
they're,
trained
to
assess
and
refer
patients.
But
let
me
be
clear
with
the
committee
so
that
it's
a
real
understanding,
a
pharmacist,
does
not
diagnose
and
will
not
diagnose.
They
manage
drug
therapy,
they
do
not
prescribe,
but
they
can
initiate
and
modify
the
drug
therapy.
So
I
just
wanted
that
clear
for
the
the
committee
members
so
that
they
understand
that
this
is
what
this
bill
is
is
preparing
the
pharmacist
to
be
able
to
do.
E
A
F
So
this
is
adam
porter
again
for
the
record
a-d-a-m-p-o-r-a-t-h.
I
am
the
director
at
large
for
legislation
for
the
nevada
society
of
health
system.
Pharmacists.
I've
been
a
practicing
pharmacist
in
nevada
since
2006,
I'm
a
board-certified
pharmacotherapy
specialist
and
a
board-certified
ambulatory
care
pharmacist.
F
I've
been
working
with
physicians
and
other
providers
in
collaborative
practice
models
since
2010
here
in
our
state.
Over
the
last
decade,
I've
had
the
opportunity
to
come
to
the
legislature
on
multiple
occasions
to
talk
about
the
practice
of
pharmacy
and
the
benefits
of
utilizing
pharmacists
in
a
team
based
model
to
improve
patient
access
and
health
related
outcomes.
F
At
renown,
I've
had
the
opportunity
to
create
a
number
of
collaborative
practice
agreements
to
help
patients
with
a
variety
of
disease
states,
including
anemia
blood,
thinner
management,
blood
pressure,
cholesterol,
diabetes,
heart
failure,
hepatitis
c
polypharmacy,
which
is
when
patients
are
just
taking
a
lot
of
different
medications
and
smoking
cessation
and
the
results
have
been
consistent.
Pharmacist
co-management
of
patients
improves
outcomes.
F
Our
most
recent
evidence
of
this
compared
diabetic.
Patients
referred
to
a
pharmacist
at
renown
to
those
receiving
usual
care
patients.
Seeing
pharmacists
had
significantly
greater
reductions
in
their
hemoglobin
a1c,
which
is
a
measure
of
their
blood
sugar
control
and,
on
average
lost
20
more
pounds
than
those
patients
receiving
usual
care.
Pretty
amazing
results
in
2017,
sp
260
was
passed,
revising
pharmacy
collaborative
practice
law
in
our
state.
F
Unfortunately,
as
we
talked
about
today,
given
the
rather
restrictive
language
of
the
bill,
we've
not
seen
the
significant
growth
in
collaborative
practice
that
we
expected,
especially
in
the
community,
setting
restricting
referrals
to
a
pharmacist
to
only
the
physicians
and
other
providers
who
have
physically
signed
onto
the
pharmacist's
collaborative
practice.
Agreement
simply
doesn't
work
in
the
community
pharmacy
environment,
as
was
already
mentioned,
the
current
pandemic
has
had
some
silver
lining
in
regards
to
patient
care
access.
F
F
The
nevada
society
of
health
system
pharmacist
fully
supports
sp
229,
and
I
myself
personally
as
a
pharmacist
and
became
excited
to
support
the
bill.
I
think
it's
a
positive
step
forward
for
access
to
care
in
our
state
and
addresses
some
of
the
frustrations
that
we've
seen
since
the
law
in
2017..
Thank
you.
A
C
Color
with
the
last
three
digits
of
one
two
four
please
release
date
and
spell
your
name
for
the
record.
You'll
have
two
minutes.
You
may
begin
good
afternoon,
chair
and
members
of
the
committee
for
the
record
paul
moradkin
m-o-r-a-d-k-h-a-n
with
the
vegas
chamber.
The
chambers
is
in
support
of
senate
bill
229
and
appreciates
the
bill's
sponsor
for
bringing
the
bill
forward
today,
as
review.
As
you
heard,
this
bill
would
be
another
tool
and
expanding
healthcare
access
and
conveniency
for
nevadans.
C
As
we
work
to
address
the
doctor
shortage
in
our
state,
this
bill
will
help
us
address
services
in
the
short
term
for
the
benefits
of
patients.
We
also
view
this
bill
in
allowing
for
greater
efficiencies
within
nevada's
healthcare
delivery
system.
Thank
you,
chair
and
members
of
the
committee
for
your
time
today.
I
C
L
Good
afternoon
my
name
is
vasuda
gupta
v-a-s-u-d-h-a,
last
name
g-u-p-t-a,
I'm
an
associate
professor
at
roseman
university
college
of
pharmacy
and
a
board
certified
clinical
pharmacist
at
a
federally
qualified
health
center
in
henderson
nevada,
I'm
representing
nevada
pharmacy
alliance,
and
we
fully
support
senate
bill
229.
As
part
of
my
clinical
responsibilities.
L
L
The
providers
that
I
work
with
will
attest
that
I
am
a
valuable
part
of
the
healthcare
team
helping
to
improve
care
through
medication
management.
This
is
especially
true
for
diseases
that
are
mostly
managed
through
complex
group
of
medications
and
require
significant
education,
for
example,
diabetes.
No
other
health
care
providers
receive
four
years
of
a
doctorate
education.
L
However,
most
community
health,
centers
and
primary
care
offices
don't
employ
a
clinical
pharmacist
to
provide
these
services.
Majority
of
the
pharmacists
are
located
in
community
pharmacies
and
the
current
restrictions
in
implementing
the
cpa
in
a
pharmacy
limit
the
provision
of
care
and
make
it
impossible
for
pharmacists
to
be
able
to
provide
these
services.
L
Sb
229
allows
for
appropriate
loosening
of
those
restrictions
so
that
unnecessary
requirements
don't
hinder
pharmacists
from
using
their
medication,
expertise
to
expand
access
to
health
care
for
nevadans
nevada
is
ranked
48th
in
the
nation
for
primary
care.
Physician
access
and
allowing
pharmacists
to
practice
effectively
within
their
scope
of
knowledge
and
abilities,
will
increase
access
to
care
and
ultimately
reduce
healthcare
burden
and
costs.
Thank
you
so
much
for
the
opportunity
to
speak.
C
Caller
with
the
last
three
digits
of
951,
please
slowly
state
and
spell
your
name
for
the
record.
You'll
have
two
minutes
and
they
begin
hi
crystal
riccio,
k-r-y-s-t-a-l
last
name
r-I-c-c-I-o
for
the
record.
I
am
a
22-year
resident
of
nevada
and
an
associate
professor
of
pharmacy
practice
with
roseman
university
and
one
of
the
very
few
primary
care
pharmacists
in
nevada.
C
Today,
I'm
speaking
personally
in
support
of
bill
229,
increasing
access
to
care
for
nevadans
in
rural
frontier
and
even
urban
communities.
Many
of
these
residents
live
in
a
desert
both
literally
and
figuratively,
within
a
medical
desert.
Nevada
has
a
disparate
shortage
of
primary
care.
Physicians
in
this
bel
bill
is
a
step
in
the
right
direction
to
increasing
access
to
medical
care.
C
Within
the
scope
of
my
practice,
I
am
board
certified
as
an
ambulatory
care
pharmacist
and
after
thousands
of
hours
of
practice,
I'm
also
a
certified
diabetes
care
and
education
specialist.
Despite
years
of
practice,
developing
rapport
and
trust
with
physicians
and
patients
alike.
Barriers
in
our
past
and
present
legislation
assuaged
my
pursuit
of
a
collaborative
practice
agreement.
C
Unfortunately,
practice
without
a
cpa
creates
its
own
barriers
requiring
physicians
to
be
on-site
during
all
of
my
patient
encounters
and
requiring
me
to
interrupt
a
physician's
own
practice
day
to
get
approval
for
any
medication
changes.
I
recommend
specifically,
this
has
caused
me
to
cancel
patient
appointments
due
to
physician
illness,
physician
off-site
meetings
and
our
last-minute
physician
schedule
changes.
Despite
these
barriers,
we
avoided
pursuing
a
formal
cpa
due
to
the
cumbersome
process
required
for
initial
approval.
Consistent
amendments
based
on
frequent
guidelines
and
medication
changes
an
annual
renewal
process
all
through
the
nevada
board
of
pharmacy.
C
A
So
much
for
your
testimony,
miss
ruscio.
We
do
need
to
move
on
to
the
next
caller,
I'm
it
sounded
like
you
were
reading
from
a
document.
So
if
you
would
just
please
email
that
over
to
our
committee
manager,
she
can
include
it
in
the
record
and
send
it
to
all
of
the
members
on
the
committee.
Thank
you
broadcasting.
Next,
caller.
C
L
Hello,
my
name
is
dr
amy
hale
a-m-y-h-a-l-e
for
the
record.
I
am
a
doctor
of
pharmacy
and
a
clinical
pharmacist
for
optimal
cancer
care
in
las
vegas
nevada.
I
would
like
to
voice
my
support
for
senate
bill
229.
I
previously
worked
under
a
collaborative
practice
agreement,
but
we
did
let
it
lapse
due
to
many
difficulties
we
encountered,
including
delays
and
approval.
L
If
we
wanted
to
adjust
new
language
or
any
of
the
pharmacist
provided
services,
I
have
the
full
support
of
all
nine
physicians
with
whom
I
work
and
they
did
all
sign
the
previous
cloud
or
practice
agreement.
Pharmacists
as
medication
experts
have
patients
referred
to
us
command
their
medication
therapy
after
a
provider
makes
a
diagnosis.
L
L
Most
physicians,
who
trained
with
clinical
pharmacists,
will
speak
to
how
they
utilize
pharmacists,
to
make
these
patient
care
decisions,
and
they
still
routinely
consult
pharmacists,
recognizing
us
as
critical
members
of
an
interdisciplinary
health
care
team.
I
personally
have
a
97
acceptance
rate
for
my
interventions
and
I
directly
cause
the
reduction
of
approximately
20
thousand
dollars
per
month
in
unnecessary
prescribing
when
we
compared
our
providers
prescribing
practices
from
before
having
a
pharmacist
to
one
year
later.
One
issue
we
encountered
after
dissolution
of
my
collaborative
practice
agreement
is
an
increased
burden
on
our
providers.
L
Now
they
must
be
repeatedly
interrupted
to
implement
these
changes
that
they
felt
were
well
within
the
scope
of
practice
of
a
trusted
pharmacist
or
they
would
not
assign
the
original
agreement.
Removing
barriers
to
collaborative
practice.
Agreements
allows
for
more
comprehensive
health
care
teams
and
actually
greater
communication
between
providers,
pharmacists
and
patients.
L
It
can
reduce
delays
and
care
by
having
a
pharmacist
immediately
resolve
issues
with
the
medication
instead
of
waiting
for
a
patient
to
schedule
again
with
a
provider,
and
it
can
augment
the
patient
provider
relationship
by
having
more
trained
eyes,
evaluate
a
patient's
therapy
which
results
in
better
controlled
health
care
costs
and
improved
outcomes
for
both
efficacy
and
patient
safety.
I
want
to
thank
you
all
for
your
time
and
I
am
grateful
for
the
opportunity
to
have
spoken
with
you
all.
C
Follow
the
last
three
digits
of
zero
zero
five,
please
slowly
state
and
spell
your
name
for
the
record.
You
have
two
minutes
hello.
My
name
is
ken
conkey
k-e-n-k-u-n-k-e,
and
I'm
here
today
representing
the
nevada
pharmacy
alliance.
It
is
an
alliance
that
is,
it
represents
pharmacists,
technicians
and
students
throughout
the
whole
state
of
nevada.
C
I'm
here
to
show
our
support
of
senate
bill
229..
First,
I
want
to
say
that
currently
48
states
have
collaborative
practice
laws.
Some
of
those
are
very
restrictive
like
ours,
but
others
are
allowing
pharmacists
to
truly
use
the
the
skills
that
they
learn
in
school
to
treat
the
patients
at
the
best
of
their
ability.
C
If
you
look
under
the
senate,
commerce
and
labor
exhibits
the
collaborative
practice
agreement,
workshop
report
and
team-based
collaborative
practice
agreements.
Those
are
two
documents
that
have
been
worked
with
groups
such
as
the
cdc,
the
american
association
of
nurse
practitioners
and
the
ama,
the
american
medical
association.
C
So
some
of
the
questions
and
concerns
that
you
had
earlier,
I
would
direct
you
towards
them
documents
to
scan
through
just
so
you
can
get
your
concerns
answered.
I
just
would
say
thank
you
so
much
for
considering
this.
It's
something
that
nevada
desperately
needs
is
to
open
up
these
collaborative
practice
agreements
and
I'm
asking
you
to
show
support
of
senate
bill
229..
Thank
you.
M
A
C
A
L
G
Thank
you,
chair
haruki.
I
would
just
say
again
senator
senator
julia
ready
for
the
record.
I
do
believe
that
collaborative
practice
agreements
have
a
significant
ability
to
increase
access
to
care
and
increase
quality
of
care
for
nevadans
and
that
the
law
that
we
have
it
as
written
today
is
too
restrictive
and
therefore
is
reducing
the
amount
of
these
agreements
and
therefore
the
benefit
to
nevadans.
So
I
would
urge
the
committee's
support
in
this
effort
to
strike
the
right
balance
between
protective
patient
safety
and
making
sure
that
we
have
access
to
care.
G
A
Thank
you
senator.
I
hope
we
were
able
to
get
you
and
the
doctor
in
time
to
your
next
presentation.
Okay,
with
that,
I
will
close
the
hearing
on
senate
bill
229..
A
next
step
on
our
agenda
agenda
is
senate
bill
112..
I
would
invite
the
senators
to
present.
Thank
you
for
your
patience.
We
are
now
opening
the
hearing
on
senate
bill
112,
which
exempts
certain
products
for
the
treatment
of
certain
animals
from
regulation
under
state
law.
Senator
hansen.
D
Very
good
I'm
ira
hansa,
I
represent
senate
district
14,
which
is
38,
000
square
miles
of
nevada
represents
most
of
washoe
county
and
all
of
humboldt,
lander,
esmeralda,
mineral
pershing
and
a
big
section
of
nye
county
and
agricultural
issues
are
very
big
there.
Needless
to
say,
I
I
have
to
say
I
served
three
terms
on
this
committee
in
the
assembly
and
it
was
very,
very
enjoyable
to
sit
here
and
hear
vice
chair
carlton.
D
Ask
those
questions.
What
a
lot
of
you
may
not
know
is
senator
car
or
assemblywoman
carlton
actually
was
term
limited
out
of
the
senate
and
then
in
2010.
She
ran
for
the
assembly
and
she
and
I
came
in
as
freshmen
together,
but
of
course
she
had
already
served
six
legislative
terms
and
when
I
was
in
commerce
and
labor,
I
sat
next
to
her
a
couple
of
times
and
I
have
to
tell
you
the
truth,
and
that
is,
I
got
so
lazy.
I
would
simply
lean
over
to
maggie
and
say
maggie.
D
How
are
you
going
to
vote
on
this
issue,
the
institutional
knowledge
that
she
has
and
and
I'm
not
saying
it's
the
flat
or
anything
else?
The
last
time
she
walks
out.
D
Natural
resources,
I
got
that
in
my
office
still
and
her
signature
on
it,
no
in
all
seriousness
when
she
leaves
the
building
for
the
last
time
as
a
legislator,
because
this
she'll
be
turned
out
of
the
assembly
this
time
the
amount
of
institutional
knowledge
that
she
has
and
the
experiences
she
has
especially
on
this
committee
is
just
simply
incalculable
and
unreplaceable,
and
I'm
not
saying
that
to
flatter
her
in
the
least
she's
also
been
very,
very
good
for
rural
nevada.
She
really
has
considering
she's
a
city
slicker
from
las
vegas
she's
been
really
good.
D
Now,
having
said
all
that
this,
this
bill,
why
my
name
is
on
it
is
actually
what
happens
when
the
your
leader
has
too
many
bdr
commitments
and
he
needs
an
extra
bill
senate
bill.
112
is
actually
on
behalf
of
senator
settlement.
That's
what
he's
sitting
up
here!
He
is
going
to
present
the
bill,
I'm
fully
supportive
of
it.
It's
a
great
idea.
Frankly,
it
just
brings
nevada
law
in
compliance
with
federal
law,
but
he
will
be
able
to
answer
the
great
details
on
it.
D
Madam
chair,
with
your
permission,
I'm
going
to
turn
it
over
to
settle
senator
settlemyre
and
I'll
slip
out,
and
I
wasn't
flattering
her
in
the
least
I'm
totally
sincere
about
that
and
by
the
way
we
don't
get
along
on
everything,
but
we
sure
did
on
those
issues,
and
it
was
a
real
pleasure
to
hear
her
once
again.
In
her
brilliant
analysis,
I
would
read
those
bills
and
go
right
over
my
head
and
sit
down
next
to
her
and
she'd
start
asking
questions
like
holy
smokes.
I
didn't
see
any
of
that
anyway.
D
N
Thank
you,
madam
chair.
I
appreciate
that,
but
since
senator
hansen
already
has
senator
carlton
at
yes,
I'd
be
remiss
to
just
shut
up
and
ask
for
a
vote,
so
we
can
all
leave
yeah
darn
anyways.
This
is
senator
james
settlemeyer.
I
represent
senate
district
17,
which
represents
all
the
douglas
all
the
lion,
all
the
story
and
all
of
churchill
county.
N
This
bill
goes
back
to
actually
the
1930s
when
ranchers
started
to
see
a
situation
where,
within
their
herd,
they
started
to
see
loss
specifically,
the
cows
would
miscarriage
in
the
beginning
of
the
third
trimester-
and
I
remember
as
a
kid
being
12
years
old,
walking
out
with
my
dad
well
going.
What
what's
going
on
here,
you're,
seeing
a
bunch
of
little
fetuses
out
there
with
just
the
beginning
of
hair
on
them,
and
it
was
very
well
sad
sickening
on
how
to
put
it.
D
N
N
Traditional
is
about
forty
percent.
Our
herd
was
about
twenty
thirty
percent.
When
we
lost
our
range
land
in
california,
we
went
down
to
about
zero
because
it's
related
to
the
foothills,
hence
the
term.
In
that
respect,
it
was
interesting
that
davis
was
looking
at
it,
couldn't
figure
out
what
the
problem
was,
but
unr
stepped
in
and
determined.
It
was
a
deer
tick
that
jumps
off
the
deer
and
then
jumps
onto
a
cow
bites
it
and
causes
this
to
occur.
N
N
Well,
in
the
year
2000
they
finally
came
out
with
molecular
molecular
biology
which
allowed
them
to
figure
it
out
from
that
time
frame
in
2004,
unr
worked
in
collaboration
with
uc
davis
and
came
up
with
a
vaccine
to
this
disease.
Came
out
just
recently:
well,
they
finally
figured
out
the
z.
Unr
was
one
of
the
predicators
for
figuring
out.
That's
fantastic,
then,
all
sudden,
the
drug
company
that
manufactured
it
ran
into
a
snag.
N
They
determined
that
in
if
they
went
through
the
state
board
of
pharmacy,
it
would
put
them
in
violation
of
federal
law,
because
again
this
is
a
biologic
and
it
is
only
used
in
cattle
and
it's
not
a
disease
that
crosses
species.
So
therefore
it
is
only
to
be
regulated
by
the
united
states
department
of
ag.
N
Well,
this
created
a
situation
where
then
we
had
veterinarians,
such
as
jj
gokuchiya
and
my
veterinarian,
randy
wallstrom
driving
to
california
to
buy
vaccine
in
california
to
then
truck
it
back
to
nevada
for
disease
nevada
actually
figured
out
how
to
cure.
Well
that
didn't
make
a
lot
of
sense,
so
I
reached
out
to
the
pharmacy
board.
They
worked
on
some
emergency
regulations,
but
agreed
that
we
need
to
clarify
this
within
statute
so
that
we
did
not
necessarily
be
in
this
problem
again,
however,
wanting
to
make
it
extremely
narrowly
tailored
to
come
to
that
solution.
N
A
Thank
you,
senator
committee
members.
Any
questions.
I
And
thank
you
senator
senator
sotomayor.
I
followed
you
most
of
the
way,
but
I'm
trying
to
figure
out
so
currently.
I
If
I
heard
you
correctly,
this
is
encapsulated
in
under
our
pharmacy
board
as
far
as
distribution
goes
right
now,
and
what
you're
trying
to
do
is
say
that
this
particular
because
it
only
can
be
used
on
cattle
and
goats
you're,
proposing
to
have
it
regulated
under
the
a
a
federal,
a
usc
chapter.
Instead.
N
Thank
you.
Senator
suttlemaire,
for
the
record
in
other
states,
they've
grown
a
little
bit
larger
than
the
state
of
nevada,
and
so
they
don't
necessarily
have
the
pharmacy
board
dealing
with
a
lot
of
the
agricultural
stuff
that
is
sometimes
dealt
with
through
their
own
department
of
ag,
and
in
that
respect
the
other
states
have
decided,
in
my
opinion,
rightly
so-
that
since
federal
law
precludes
us
from
regulating
these
substances
because
it
is
exclusive
jurisdiction
and
dominion
of
the
united
states
department
of
ag
per
federal
law
that
there's
no
reason
to
get
involved.
N
This
is
senator
settlemeyer.
Most
other
states
have
determined
since
it
is
exclusively
and
can
only
be
regulated.
Yes,
that
is
only
to
be
regulated
by
the
feds.
Our
state
necessarily
hadn't
come
up
with
this
discussion,
because
most
diseases
within
agriculture
are
cross
species,
sometimes,
as
we
have
unfortunately
just
found
out.
I
I
I
think
that
answers
most
of
my
questions,
I'm
just
a
little
concerned
that
if,
if
the
pharmacy
board
is
regulating
things
that
it
really
shouldn't
be
because
of
the
change
that
that
we
should
have
the
conversation
about
that,
but
it
seems
as
though,
with
this
federal
citation,
you
you've
taken
care
of
this
one
particular
issue.
So
it
looks
like
we're
just
going
to
have
to
take
care
of
them
one
at
a
time
as
we
we
move
through
this
senator
settlemyre.
N
If
I
could,
madam
chair
specifically,
it
states
that
everyone
that
falls
under
the
ver
virus
serum
talks
in
act,
which
I
apologize
for
not
having
off
the
top
of
my
head.
What
year
that
went
into
effect,
but
I
want
to
say
it
was
like
the
80s
or
something
of
that
nature,
and
I
was
trying
to
phone
a
friend
over
there
who
works
for
the
pharmacy
board.
That
has
that
information.
N
If
you
fell
under
this
categorization
and
again,
you
fell
within
to
the
livestock
that
we
have
deemed
that
are
not
highly
people,
don't
have
a
ton
of
cows
living
in
their
house,
and
so
there's
no
issue.
Don't
have
a
lot
of
goats
necessarily
living
in
their
house.
However,
they
may
have
felines
and
they
may
have
canines.
N
So
we
wanted
to
make
sure
to
be
as
narrowly
tailored,
but
if
there
are
other
biologics
that
fit
within
the
united
states
department
of
ag
21's
toxin
act,
they
also
would
be
considered
to
be
outside
the
scope
and
not
have
to
go
through
that.
This
is
the
first
one
we
knew
of,
but
let's
say
that
they
come
up
with
something
else
that
again,
the
feds
have
dictated
us
only
to
be
regulated
by
the
federal
government
that
the
state
of
nevada
wouldn't
necessarily
continue
it.
N
In
order
to
try
to
do
this,
however,
we
wanted
to
make
sure
that
we
were
not
so
wide
and
so
broad
that
we
would
be
giving
up
authority
on
things
that
somehow
some
way
could
become
domesticated
or
within
one's
home.
That
was
our
desire
and
the
desire
within
the
definition
of
livestock,
in
that
categorization
of
nrs
571-022.
N
Thank
you
for
that
question,
madam
chair.
Vice
chair,
senator
settlement
for
the
record.
This
particular
one
in
question
is
actually
much
like
pfizer
has
to
be
carried
in
sustained
in
cold
storage,
liquid
nitrogen
minus
127
degrees,
so
in
general
it
is
something
that
is
always
done
only
by
a
veterinarian.
It
can
only
be
purchased
again
by
the
veterinarian.
N
Most
veterinarians
traditionally
only
transfer
it
from
their
house
to
the
location
when
dealing
with
liquid
nitrogen,
which
they
deal
with
on
a
regular
occurrence
and
they're
rather
skilled
at
you,
know,
dealing
with
it
because
they
deal
from
everything
from
vaccines
to
semen
and
embryos.
However,
in
this
particular
situation,
they
really
didn't
like
the
idea
of
having
to
drive
across
the
state
line
to
do
that.
A
And-
and
I
have
a
question
for
you
senator
you
said
that
this
would
only
apply
to
cattle
and.
A
So
the
definition
of
571.022
it
also
includes
birds,
dogs,
cats,.
N
So
to
be
all
catalan
animals
or
horses,
murals
bureaus
horses,
animals
equine
species,
all
swine
or
animals,
it
skips
goats
and
it
skips
sheep,
but
includes
poultry
and
that's
it.
Then
it
leaves
out
all
dogs
and
cats
and
all
alternative
livestock.
This
was
requested
by
the
not
only
the
industry,
but
also
by
the
pharmacy
board,
who
crafted
these
amendments
to
the
bill
to
get
us
to
this
stage.
A
N
Has
a
meaning
described
to
it
in
subsections,
one
and
three,
two:
six
inclusive
of
nrs
571.022,
which
would
mean
that
it
would
only
include
one
and
three
which
is
cattle
and
bovines:
three
swine
and
animals
of
porcine
species
and
then,
of
course,
three
to
six,
which
would
get
you,
the
goats,
the
sheep
and
the
poultry,
but
not
seven
and
eight,
which
is
dogs
and
all
cats
and
all
domesticated
and
all
alternative.
Livestocks.
A
A
Okay,
seeing
none
let's
go
ahead
and
move
into
testimony
and
support.
Is
there
anyone
in
carson
city
wishing
to
testify
in
support?
Okay,
seeing
none
is
there
anyone
on
zoom
wishing
to
testify
in
support
okay
broadcast?
Could
we
check
the
telephone
line
for
those
wishing
to
testify
in
support
of
senate
bill
112.
A
A
N
A
K
O
O
About
a
year
and
a
half
ago
I
was
honored
by
governor
siselek
to
be
appointed
to
his
board
of
pharmacy
as
the
public
member.
Coincidentally,
at
that
time,
the
governor's
audit
division
just
completed
a
review
of
the
board
of
pharmacy.
After
that
they
review
they
made
five
recommendations,
four
of
which
were
already
implemented
and
are
part
of
our
policies
and
procedures.
O
O
Now
it
falls
under
control
for
storage,
inventory
control
and
dispensing
now
prior
to
my
getting
into
the
gaming
industry,
I
spent
31
years
as
a
special
agent
for
the
federal
bureau
of
investigation,
my
expertise
and
my
specialty
was
federal
electronics
investigation.
In
fact,
I
spent
the
last
eight
years
of
my
bureau
career
right
here:
working
federal
narcotics
investigations
in
nevada,
the
greatest
tool
I
had
for
vetting
the
subjects
of
my
investigation
was
the
national
background
check
those
background
checks
can
give.
O
You
will
tell
you
a
lot
about
subjects
or
an
individual's
character,
their
propensity
to
commit
another
crime,
their
tendencies.
You
read
a
lot
into
it
and
I
think
that
this
board
of
pharmacy
needs
this
tool
to
vet
those
pharmacists
and
pharmacists
technicians
that
are
in
control
of
all
the
narcotics
in
this
state.
I
think
that
the
the
general
public
of
which
some
women
and
assembly
women
you
are
the
general
public.
O
O
K
You
all
right
dave
wiest
for
the
record
good
afternoon,
always
difficult
to
follow
chief
tommaso
there.
So
I
appreciate
you
dick
all
right.
Thank
you,
chair
and
members
of
the
committee
for
your
consideration
of
sb
408.
This
bill
clarifies
it
makes
more
consistent,
various
provisions
of
existing
law
that
govern
how
the
board
operates.
K
It
implements
recent
recommendations
that
were
made
either
by
the
sunset
committee
or
by
the
executive
branch
auditors,
and
it
helps
the
board
protect
the
public
to
the
greatest
extent
possible
to
make
assuring
that
we
have
reliable
pharmaceutical
care
I'll
just
run
through
the
sections
really
quick
being
sensitive
of
your
time.
Section
two
removes
a
provision
that
clearly
conflicts
with
the
open
meeting
law
in
in
statute.
So
we're
just
blending
that
in
to
be
with
the
use,
the
more
transparent
language
section
three
clarifies
the
board's
authority
to
perform
two
essential
functions.
K
First,
the
board
routinely
enters
into
agreements
with
local
state
and
fellow
agencies
to
coordinate
our
efforts
and
better
protect
the
public.
Second,
the
board
has
a
baoe
approved
contract
with
apparis
to
administer
the
pmp,
and
the
board
would
like
both
of
these
functions
to
be
clearly
specified
in
nrs
section
4
amends
nrs
639.100
and
simplifies
the
statute
to
clarify
that
is
unlawful
to
manufacture
wholesale
compound
seller
dispense
prescriptions
in
nevada
unless
properly
licensed
sections
five
and
six
require
the
applicant
to
be
registered.
Sorry
sections
five
and
six
require
the
applicants
to
be
registered.
K
Pharmacists
and
pharmaceutical
technicians
undergo
criminal
background
checks.
This
recommendation
was
made
by
the
executive
branch
audit.
Currently,
the
only
person
that
background
checks
apply
to
are
operators
of
wholesalers,
many
other
states,
as
dick
said
they
have
such
a
requirement.
This
is
ultimately
a
policy
decision
that
rests
with
you.
I
did
come
up,
obviously,
on
the
senate
side,
this
is
moving
forward,
not
not
going
back
and
doing
background
checks
on
all
the
current
licensees,
but
this
is
as
new
people
would
apply.
K
Section
11,
which
relates
makes
conforming
amendments
to
protect
the
criminal
history
once
the
board
has
it
from
under
unauthorized
use
or
disclosure,
as
required
by
the
fbi.
Section
seven
increases
the
statutory
limits
on
the
bi-annual
fee
to
be
licensed,
as
a
manufacturer
wholesalers
manufacture
a
wholesaler
from
500
to
a
thousand
dollars.
This
is
a
result
of
a
sunset
committee
recommendation
of
the
board,
analyze
its
fee
structures
and
revise
fees
to
the
extent
necessary
to
support
its
operation.
K
Currently,
the
board
cannot
increase
fees
for
manufacturers
wholesale
to
cover
the
cost
of
regulating
these
activities
because
their
statutory
limit.
This
will
remedy
that
section.
8
changes,
nrs,
639.243
subsection
2
to
conform
with
the
20-day
period
of
filing
an
answer
and
notice
of
defense,
so
it
just
it
just
tidies
that
up
section
10
amends
nrs639.281
to
clarify
that
it
is
unlawful
to
obtain
a
license
from
the
board
under
fake
pretenses
or
false
representation
of
one
cell
oneself.
As
a
holder
of
a
license
section
13
repeals
nrs.
K
639.095,
which
requires
that
the
board
provide
free,
copies
paper,
copies
of
the
ch
of
their
chapters
in
nac.
This
requirement
is
outdated,
not
necessarily
because
the
revel,
the
laws
sorry
are
accessible
on
the
board's
website.
I
thank
you
for
your
consideration
of
this
bill
and
can
answer
any
questions.
G
Thank
you
chair
and
thank
you,
mr
whis,
for
the
presentation,
assemblywoman
harry
kasama
district
2..
My
question
is
in
section
2
3
relating
to
where
you
deleted
the
section
on
administrative
action.
Could
you
could
you
give
an
example
of
the
difference
between
administrative
action
because
you're
removing
that
and
the
administrative
examinations
that
are
closed
to
the
public.
K
Yeah,
so
the
board
actually
does
these
all
up
in
in
the
public.
The
current
statute
would
allow
us
to
do
those
administrative
actions
in
closed
session,
but
the
board
doesn't
when
we
are
looking
at
the
character,
competency
of
an
applicant
and
they
they
can
still
request
that
it
can
be
in
a
closed
session
and
the
board
votes
to
see
if
they're
going
to
do
that
or
not.
But
99
percent
of
the
board's
activities
at
a
board
meeting
are
open
to
the
public
and
I
think
that's
the
way
the
board
likes
it.
A
It's
okay,
teamwork,
members.
K
K
We
had
no
fee
increases
in
the
last
21
years
at
that
time,
and
so
that
the
sunset
committee
made
us
take
a
hard
look
at
the
activities
that
we're
doing
and
the
fees
that
we're
charging
we
did
implement
some
increases
to
other
fees
that
were
within
statutory
guides
or
allowable
dollar
amounts,
but
the
wholesalers
we
were
way
under
what
other
states
were
doing,
not
the
reason
to
increase
it.
But
we,
as
dick
said
we
had
to
change
how
we
were
doing
the
wholesalers,
so
we've
had
an
increase
in
activities.
K
I
K
These
fees
are
not
really
related
to.
If
you're
talking
about
the
investigation
of
an
applicant,
we
we
we
have
to
run
the
fingerprints.
We
have
to
interact
with
the
fda,
to
see
if
they're
a
licensed
wholesaler,
we
have
to
interact
with
their
current
state
to
make
sure
they're
in
good
standing
and
all
those
kinds
of
things.
So
that's
what
the
fees
go
towards.
I
And-
and
I
appreciate
that
been
working
with
these
boards
for
a
very
long
time
so
when
I
see
that
the
investigation
or
issuance
of
the
original
license
is
up
to
a
certain
amount,
but
then
I
see
the
renewal
is
also
up
to
that
amount,
realizing
that,
yes,
these
are
caps.
I
The
original
investigations
and
issuance
are
always
much
more
expensive
than
the
renewals,
because
the
file
has
already
been
established.
All
the
original
documentation
has
already
been
collected,
and
it's
just
a
matter
of
updating
everything
and
making
sure
everyone
is
still
legitimate
and
hasn't
gotten
themselves
in
trouble
over
the
last
couple
of
years.
So
I
was
just
wondering
what
the
actual
real
cost
of
the
investigations
for
the
original
license
were
versus
what
the
actual
time
and
effort
was
on
on
the
renewal,
because
you're
setting
the
cap
at
the
same
limit.
So
that's
where
my
question
comes.
K
From
dave
wiese
for
the
record,
I'm
not
sure
was
there
a
follow-up
question.
I
K
The
same
yeah,
so
I
think
that's
that's
if
you
want
the
actual
dollar
amounts.
I
can
definitely
provide
you
to
that
after
this
meeting.
I
understand
your
point
that
the
upfront
investigation
is
more
expensive
than
potentially
renewal,
but
when
we're
coming
from
a
place
where
this
is
not
something
that
the
board
even
took
into
account,
and
then
we
had
an
a
a
instance
where
certainly
the
audit
staff
pointed
out
that
there
was
a
deficiency,
it
took
a
whole
revamping
of
the
of
of
how
we
were
doing
that
licensure
for
that
category
and
we've.
K
You
know:
we've
added
people
to
do
background
checks.
A
O
J
Thank
you,
madam
chair,
and
I
have
one
question
specific
to
the
bill
and
another
question
that
may
be
directed
towards
legal
counsel.
So
the
first
one
is
just
on
the
last
page
of
the
bill:
the
text
of
the
repealed
section
that
we're
removing
the
requirement
that
boards
furnish
free,
copies
of
law
and
regulations
for
applicants
and
registrants,
and
I
was
just
wondering
if
you
could
elaborate
a
little
bit
more.
Is
that
because
we're
just
directing
them
to
see
that
online
or
what
the
reasoning
was
for
repealing
that
section.
K
Yeah
dave
wiest
for
the
record
excellent
question.
Currently
the
board
will
print
out
a
hard
copy
of
the
laws
and
send
it
to
an
applicant
and
that's
generally
related
to
them
studying
for
the
test
or
whatever
and
in
today's
world
they're
electronic.
So
we
don't
get
a
lot
of
requests
for
the
the
paper
ones,
because
people
can
get
them
themselves
on
their
device
and
we're
just
trying
to
remove
that
requirement
of
you
know
the.
J
Paper
you
for
that
clarification,
and
then,
madam
chair
follow-up,
thank
you
and
again.
This
may
be
better
suited
for
legal
counsel,
and
I
may
need
to
take
it
offline.
But
last
session
we
passed
ab319
this
body
passed
ab319
which
set
up
a
process
by
which
all
boards
who
conduct
criminal
investigation,
background
checks
for
applicants,
provided
a
process
for
an
applicant
or
for
an
individual
with
a
criminal
history
to
be
able
to
solicit
an
opinion
from
the
board
if
they
were
automatically
disqualified
before
they
began
that
process.
J
If
their
criminal
history
would
automatically
disqualify
them
from
being
able
to
be
licensed
and
would
would
the
provisions
that
we
passed
in
all
the
applicable
chapters
from
chapters
6
24
to
648,
which
I
believe
639
would
then
fall
into?
Would
that
also
carry
over
to
this
bill
in
this
chapter?
And
that
may
be
a
question
for
illegal
because
it's
not
actually
written
into
this
bill
and
because
you
didn't
have.
A
A
Okay,
mr
we
I
did
have
one
I
just
it's
more
of
just
a
process
question
you
got
you're,
adding
language
in
that
says
that
allows
the
board
to
contract
with
a
private
entity
to
administer
the
database
of
the
program
established
pursuant
to
nrs453.162.,
and
so
it's
just
a
quick
question.
I
just
wanted
to
know
how
is
that
process
currently
handled?
Who
does
who
tracks
that
right
now
the
database
or
the
information
required
under
453
162.
K
K
I
think
that
our
attorney
wanted
that
one
it's
one
of
our
bigger
contracts
for
the
board,
and
so
I
think
our
current
our
attorney
was
recommending
that
we
just
put
in
statute.
I
think
we
we
currently
do
it
and
we
work
through
the
purchasing
department
follow
all
the
rules
for
that.
A
A
C
C
C
D-A-N-I-E-L-P-I-E-R-R-O-T-T
with
argentine
partners,
it
amp
is
finding
support
of
senate
bill
408
on
behalf
of
our
european,
express
we
legislate
technology
and
fingerprint
background
checks,
in
addition
to
a
myriad
of
other
services
to
ensure
the
safety
and
security
of
nevada's.
Currently,
there
are
over
80
industries
in
nevada
that
are
required
by
statute
to
receive
fingerprint
background
checks.
For
that
reason,
we
are
in
strong
support
of
this
legislation,
particularly
section
5,
subsection,
2
and
section
6,
subsection
4
support
the
move
to
fingerprint
our
pharmacist
and
pharmaceutical
technicians.
Thank
you
for
your
time.
Consideration.
A
Okay,
is
there
anyone
in
carson
city
wishing
to
testify
in
opposition
to
senate
bill
408?
A
A
A
K
A
Okay,
thank
you
so
much.
Okay
with
that,
I
will
close
the
bill
hearing
on
senate
bill.
408
members.
We
have
one
last
item
left
on
our
agenda
today.
It
is
public
comment
well
because
there
is
a
one
minute
lag.
We
will
go
through.
Our
public
comment
comment
housekeeping.
While
we
give
those
listening
over
the
internet
time
to
call
in.
A
Okay,
I
would
like
to
remind
those
present
and
those
listening
that
public
comment
is
an
opportunity
to
discuss
general
matters
that
fall
within
the
purview
of
this
committee.
Please
address
your
remarks
to
issues
that
fall
within
the
commerce
and
labor
committee.
If
you
direct
your
remarks
to
issues
over
which
this
committee
has
no
oversight,
I
will
ask
you
to
redirect
your
remarks
or
terminate
them.
The
public
has
already
been
given
time
to
support
or
oppose
specific
legislation.
A
We
open
and
close
hearings
on
bills
so
that
we
establish
a
record
of
the
public
testimony
on
the
bill.
Therefore,
public
comment
is
not
intended
to
be
a
continuation
of
a
bill
hearing.
I
would
like
to
remind
everyone
that
we
do
limit
public
comment
to
two
minutes.
Please
be
respectful
of
committee
members
and
other
witnesses.
Do
not
comment
on
testimony
provided
by
other
speakers
and
do
not
make
personal
attacks.
You
may
always
submit
written
remarks
for
inclusion
in
the
meeting
record
with
that
broadcasting.