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From YouTube: 3/10/2021 - Assembly Committee on Commerce and Labor
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A
C
E
A
Here
and
secretary,
please
indicate
all
committee
members
present
welcome
everyone
tuning
in
over
the
internet.
Before
we
start,
I
would
like
to
make
a
few
housekeeping
announcements.
A
Asm.Nb.Uus
members,
please
remember
to
keep
your
camera
on
at
all
times.
This
will
help
us
ensure
we
have
a
quorum
unless
you
are
stepping
away
from
your
computer
for
non-committee
related
business
members
and
presenters.
Please
remember
to
be
muted
at
all
times,
unmute
yourself
to
speak
and
then
promptly
mute
yourself
when
you
are
done.
Thank
you
to
everyone
and,
let's
begin
with
our
agenda,
we
have
to
build
on
our
agenda
today.
A
E
E
E
Why
are
prescriptions
not
available
in
multiple
languages
so
that
people
with
limited
english
proficiency
can
readily
know
what
is
in
their
prescription
bottle
and
how
they
should
take
it
in
his
paper?
English
is
not
enough.
The
language
of
food
and
drug
labels
ryan
awry
details.
The
history
of
the
food
and
drug
administration,
the
fda's
english-only
policies
in
his
paper
arai
looks
at
demographic
trends
in
america.
Then
contrasts
it
with
the
fda's
food
and
drug
label
requirement
that
labels
be
printed
in
english,
with
no
consideration
for
translation
into
additional
languages.
E
However,
the
fda
revoked
the
requirement
for
the
patient
inserts
to
be
printed
in
spanish.
Just
two
years
later,
policy
has
been
relatively
static
ever
since
so
under
the
status
quo,
health
care
facilities
receiving
fundings
from
the
federal
government,
including
medicaid
and
medicare
reimbursements,
should
provide
interpretation
and
translation
services
to
individuals
with
limited
english
proficiency.
E
For
example,
the
1964
civil
rights,
the
americans
with
disability
act
and
the
affordable
care
act
are
federal
laws
that
require
hospitals,
clinics
and
other
health
care
institutions
covered
by
federal
funding
to
provide
language
access.
However,
these
are
commonly
interpreted
to
mean
verbal
translation,
while
inside
of
the
clinical
setting
and
have
been
implemented
as
such,
including
in
pharmacies.
E
So
here's
the
problem.
The
problem
is
that
persons
with
limited
english
proficiency
are
systemically
prevented
from
having
their
prescription
labels
and
patient
information
printed
in
a
language
they
can
understand
and
it's
problematic.
The
composite
of
our
nation
is
changing
to
be
majority.
Minority
nation
and
nevada's
demographics
reflect
that
national
trend.
E
977
000
are
hispanic
origin
of
any
race
which
is
31
of
the
population,
and
the
trends
are
projected
to
grow
by
2038.
Nevada's
population
will
grow
to
just
over
3.5
million
people
of
which
nearly
in
will
be
asian
or
pacific.
Islander
and
1.3
million
will
be
hispanic,
but
what
do
we
know
about
the
ability
or
these
populations
to
have
english
proficiency?
E
Well,
we've
got
data
on
that
too.
It
doesn't
have
to
be
a
guessing
game.
On
march
9th
2000
2020,
the
gwen
center's
daniel
linden,
published
the
2020
census
in
nevada
snapshot
number
seven.
E
It
states
quote
there
are
139
census,
tracts
in
clark
county,
most
of
them
located
in
las
vegas,
wherein
more
than
10
percent
of
households
have
no
have
no
residents
over
the
age
of
14,
who
speak
only
english
or
who
speak
english
very
well,
and
at
this
point
I
am
going
to
screenshot
a
piece
of
that
report
for
you,
because
I
think
it's
important
to
see
what
we
know
about
languages
in
clark
county
specifically,
so
you
can
see
here
the
table
1
top
languages
spoken
in
clark,
county
and
percentages
of
speakers
of
those
language
who
speak
english
less
than
very
well
over
here
of
spanish
we've
got
45
percent
vietnamese
57
french
18
german
15.
E
E
E
Additionally,
the
institutes
of
medicine
reported
that
poor
comprehension
of
prescription
instructions
as
a
root
cause
of
adverse
drug
events
and
other
medication
errors.
Second,
it
makes
financial
sense
for
the
entire
health
care
system.
Adverse
drug
events
are
very
costly
to
the
medical
system,
and
many
of
them
are
preventable.
The
study
identifying
hospital-based
admissions
due
to
adverse
drug
events
using
a
computer-based
model
published
by
pharma,
epidemiology
and
drug
safety,
found
that
as
many
as
28
of
adverse
drug
events
are
preventable
and
severe
cases
have
a
trend
towards
being
the
most
preventable.
E
It
is
a
surprisingly
short
bill,
but,
as
we
all
know,
short
bills
can
be
the
ones
that
cause
us
the
biggest
amount
of
angst
or
and
can
be
the
ones
where
we
need
to
give
additional
consideration
for
all
types
of
consequences
for
them.
In
section
one
you're
going
to
see
the
requirement
that
the
label
a
prescription
label,
which
is
the
reference
you
see
in
line
six
nrs639
that
that
label
could
be
printed
in
addition
to
another
language
than
english.
E
So
remember
because
of
the
fda's
english
policy,
you
have
to
have
an
english
language
label
on
that
bottle,
so
it
would
be
an
english
label
and
then
the
label
that
the
person's
proficient
in
you'll
see
also
that
in
subsection
two,
we
are
looking
for
the
pharmacy
to
publish
a
notice
that
the
patients
can
ask
or
their
prescription
label
to
be
printed
in
an
additional
language,
and
then
those
languages
listed
that
they
can
print
in.
E
You
see
some
requirements
for
the
board
and
the
type
of
adoptions
that
they
are
going
to
have
to
adopt
and
bring
into
place,
and
then
you'll
see
the
sub
five
and
you're
going
to
hear
testimony
from
those
not
positioned
to
sub
five
and
we're
having
an
ongoing
conversation.
E
Regarding
that,
I
think
we're
going
to
end
up
in
a
good
place.
There
two
pieces
that
I
wanted
to
make
sure
you
know
that
I
am
going
to
be
working
with
stakeholders
on
is
on
subsection
one
line,
eight,
where
the
requirement
is
english
and
any
other
language.
E
Instead,
I
am
looking
to
conceptually
amend
this
based
on
demographics
within
a
given
area,
so
that
that
way
we
don't
have
an
ambiguous
prince
the
label
in
all
languages
that
are
known
in
the
world,
but
rather
what
is
happening
and
within
the
state
or
a
specific
area
of
the
state
and
then
be
a
little
bit
more
targeted
in
the
languages
that
are
available.
E
And
then
I
told
you
about
section
five,
where
we
are
looking
to
there's
a
conversation
on
that.
Then
also
that
the
notice
of
the
patient
rights
as
well.
It
seems
to
make
the
most
sense
to
have
the
board
adopt.
What
that
standard
language
would
be,
and
also
using
demographic
data
languages
that
it
should
be
posted
in
at
the
pharmacy.
So
people
know
of
their
right.
E
But
lastly,
I
want
to
say
that
one
of
the
biggest
reasons
why
I
feel
like
this
public
policy
ought
to
be
considered,
hopefully
passed,
but
really
that
we
should
contemplate
it
as
a
legislative
body
is
because
we
know
that
there
are
people
who,
once
they
leave,
that
supportive
clinical
setting
they
go
home,
they're
going
home
with
their
medications,
and
we
have
so
many
families
that
are
looking
at
that
bottle
and
can't
read
it
and
for
all
of
the
same
reasons
that
we
want
any
type
of
health
care
information
to
be
out
there.
E
All
those
reasons
that
the
fba
fda
put
patient
inserts
in
place
to
prevent
adverse
drug
effects,
they're
useless.
If
you
can't
read
them,
they're
useless.
If
you
have
a
family
sitting
in
a
home,
trying
to
google
translate
them
to
how
they
apply
a
fentanyl
patch
or
to
how
they
use
their
morphine
bottles
and
as
a
person
who
has
worked
in
health
care
for
the
past
10
years
being
in
a
home-based
setting
meaning
being
in
people's
individual
residencies.
E
When
you
have
changing
caregivers,
you
can't
just
tell
one
person
in
one
family,
something
and
just
assume
that
the
onus
is
going
to
be
on
them
or
their
children
or
extended
family
members
to
translate
all
of
this
stuff.
It
really
needs
to
be
medically
certified
translators
who
are
doing
that,
and
it's
kept
me
awake
a
lot
at
night,
worrying
about
those
kinds
of
families
and
that's
why
I
appreciate
the
time
to
discuss
this
piece
of
legislation,
and
I
will
stop
talking
now
and
allow
miss
ballard
to
talk.
F
Chair
haudaghi
vice
chair
carlton
and
members
of
the
committee,
thank
you
for
allowing
me
to
testify
in
support
of
ab177.
Today
my
name
is
kate
ballard
and
I'm
a
registered
nurse
in
oregon.
I
was
one
of
the
primary
advocates
for
sb
698,
a
very
similar
oregon
law
that
was
passed
in
2019
and
went
into
effect
january
1st
2021.
F
The
oregon
law
came
about
after
nursing,
students
working
with
patients
with
limited
english
proficiency
or
lep
noticed
a
high
rate
of
medication
error
among
this
population.
For
example,
there
was
a
mother
from
the
middle
east
who
was
highly
educated
and
spoke
multiple
languages,
but
english
wasn't
one
of
them.
She
couldn't
read
the
labels
on
her
child's
inhalers
and
was
unintentionally
giving
him
the
wrong
inhaler
during
his
acute
asthma
attacks.
This
child
was
hospitalized
for
life-threatening
asthma
attacks
that
were
unknowingly
going
untreated.
F
After
this
bill
was
introduced
to
the
oregon
legislature.
There
was
an
outpouring
of
support.
The
common
sense
legislation
resonated
with
health
care
professionals,
community
organizations
and
private
citizens
alike
simply
put
in
one
testimony.
The
only
difference
between
a
medicine
and
a
poison
is
understanding
how
to
use
it.
I
would
like
to
briefly
address
some
of
the
common
questions
about
prescription
translation
bills.
F
F
The
average
cost
of
a
single
hospitalization
for
a
preventable
medication
error
is
fifteen
thousand
dollars
which
totals
in
the
billions
of
dollars
each
year
nationally.
Experts
on
health
care
economics
agree
that
the
costs
from
language
related
medication
errors
will
continue
to
increase
over
time
unless
healthcare
providers
meet
demands
for
improved
translation
services.
F
Furthermore,
chain
pharmacies
have
had
both
the
time
and
necessity
of
integrating
translation
software.
New
york
passed.
Such
laws
in
2009
and
oregon's
law
passed
in
2019..
Second,
is
safety.
Certified
translation
companies
use
a
rigorous
multi-step
vetting
process
in
their
translation
of
prescription
labels.
F
The
risk
of
a
medication
error
is
far
lower
than
when
sending
a
patient
home
with
a
prescription
bottle
in
a
language
they
can't
read
or
understand.
In
addition,
ab177
provides
protection
to
pharmacists.
Using
these
certified
translation
companies,
they
can't
be
held
liable
for
a
translation
error.
The
third
topic
is
dual
labels.
Dual
language
labels
ensure
that
both
patients
with
lep
and
their
english
speaking,
pharmacists,
caregivers
and
providers,
know
what
the
prescription
label
says.
Here's
an
example,
the
instructional
phrase
called
a
sig
such
as
take
one
tablet
by
mouth
daily.
F
That's
called
a
sig,
so
here's
the
english
sig
and
here's
the
translation
for
the
spill
to
be
effective.
The
translated
sig
must
be
on
the
bottle,
not
in
a
supplemental
packet.
The
reality
is
that
many
patients
have
upwards
of
five
medications,
plus
kids,
with
medications
of
their
own.
It's
not
realistic
to
expect
a
patient
to
keep
track
of
five
plus
instruction.
Packets
then
match
the
correct
packet
with
the
correct
medication
bottle.
If
the
translated
sig
isn't
on
the
bottle,
the
safety
of
nevadans
will
continue
to
be
at
risk.
F
F
However,
there
are
several
options
to
address
uncommon
situations
where
extra
room
is
needed,
including
pull
out
tabs
or
folding
a
second
label
in
half
and
sticking
it
to
the
bottle,
which
is
a
common
practice
that
pharmacists
use
called
flagging
force.
Laws
in
other
states
currently
oregon
new
york
and
california,
have
laws
governing
translation
of
prescription
labels,
but
I
urge
your
caution
in
considering
the
california
law,
which
is
extremely
limited.
F
F
In
contrast,
the
oregon
law
requires
that
all
cigs
be
available
in
at
least
14
languages
and
that
the
translation
must
appear
on
the
bottle
like
oregon.
Nevada
can
certainly
do
better
to
protect
its
residents,
it's
in
a
pharmacist's
code
of
ethics
to
communicate
with
patients
in
terms
that
are
understandable
and
to
respect
personal
and
cultural
differences
among
patients.
A
B
Thank
you
so
much
I'm
out
of
chair
and
thank
you
majority
leader
for
bringing
this
bill.
I
think
it
is
also
important,
but
I
did
have
a
couple
questions
one
so
in
your
chart.
I
think
I
counted
12
languages.
Is
that
what
we're
looking
at
to
do
as
many
as
12
I
mean.
E
I
appreciate
that
so,
if
you
see
section
one
sub
three,
it
says
the
board
shall
adopt
regulations
prescribing
and
then
it
goes
into
the
languages
in
which
the
pharmacies
are
required
to
provide
the
information
and
in
other
states
they
have
taken
approach
of
kind
of
just
setting
a
number
of
a
hard
fast
number
in
statute.
I
I
I
don't
think
it's
the
best
policy
to
set
a
hard,
fast
number
in
statute.
I
would
say.
E
Instead
it
makes
the
most
sense
to
look
at
our
demographic
data
and
projections
and
then
ensure
that
we
are
serving
the
community,
as
the
data
tells
us
the
composite
of
the
community
and
so
and
so
that
that
that
would
be.
I
think
the
best
legislative
goal
would
be
to
allow
the
the
board
to
look
at
those
demographics
and
those
data
and
then
make
the
decision
on
the
number
of
languages
from
there.
So.
B
Appreciate
that
so
so
it
wouldn't
be,
you
know
in
in
washoe,
we
have
to
have
14
different
labels
right.
E
Once
again,
you
want
to
defer
back
to
what
the
data
and
demographics
are
going
to
tell
us
and
and
what
are
how
our
population
is
growing,
and
I
think
we
think
that
way.
You
you
write
a
policy
that
doesn't
have
to
come
back,
be
updated
every
decade,
you've
got
a
law
that
is
going
to
be
more
amenable
to
our
communities
as
they
change.
B
I
ask
one
more
question:
if
it's
okay,
yes,
follow
up,
thank
you
so
much
so
your
other
presenter,
I'm
so
sorry.
I
forgot
your
name,
but
you
had
talked
a
little
bit
about
cost,
but
in
general
and
what
it
would
cost.
If
we
don't
do
this,
but
what
do
you
do?
You
have
a
rough
idea
of
what
it
might
cost
to
implement
this
and
who
absorbs
that
cost?
Would
it
be
the
pharmacy
or.
E
Well,
this
through
chairwoman
haregi.
Well,
I
guess
to
assemblyman
dickman
thank
you
for
letting
me
go
through
straight
through
to
her
so
right
now,
as
the
bill
is
written.
This
is
a
this
is
absolutely
a
requirement
of
the
pharmacy
to
to
to
to
enact
this,
so
they
would
have
the
label
on
english
and
then
the
way
that
most
and
I'm
gonna
let
them
speak
for
themselves
about
their
capability.
I
don't
think
they
would
be
comfortable
with
me
speaking
for
them.
E
I
can
tell
you
what
I've
heard
in
different
conversations
about
what
they
can
and
can't
print,
but
but
it
would
be
about
the
pharmacies
right
now
ensuring
that
the
ability
to
translate
the
label.
E
Yeah
and
then
talking
with
one
fcqc
locally.
They
let
me
know
that
with
the
software
and
translation
service
they
use,
it
would
be
an
additional
50
a
month
for
them
to
get
access
to
50
more
languages.
E
Another
reason
why
I
don't
think
why
we
want
a
static
static
number
in
statute,
because
we
don't
want
to
force
people
to
artificially
purchase
more
languages
than
they
have
to,
but
some
other
systems
have
told
me
it
would
be
12
million.
So
I
think
I've
had
trouble
or
I
I
have
been
open
about
trying
to
find
a
way
for
to
reconcile
the
wide
ranges
that
people
are
talking
about
from
dollars
a
month
to
12
million.
A
G
Thank
you
very
much,
madam
chair
and
I've
got
a
couple
questions,
because
there
were
some
terms
that
were
used,
that
I
want
to
make
sure
that
I
understand
them
so,
and
I
apologize
the
the
second
presenter.
I
did
not
catch
your
name
fast
enough,
but
we
were
talking
about
medically
certified
translators
and
I
know
whenever
I
want
to
put
out
something
in
multiple
languages
or
if
I
try
to
put
up
notices
in
multiple
languages.
G
There
are
so
many
different
dialects,
and
sometimes
it
means
one
thing
if
someone's
from
a
certain
area
in
south
america
versus
someone
from
cuba
versus
someone
from
mexico.
So
I
guess
I
want
to
understand
medically
certified
translators
because
there
are
so
many
different
dialects.
I
would
hate
to
have
the
wrong
thing
out
there
and
that
kind
of
leads
me
to
my
to
the
second
question
of,
if
it
if
it
doesn't
end
up
being
correct,
who
is
actually
held
responsible.
E
Thank
you,
some
assembly,
women,
carton,
I'm
going
to
start
and
then
I'll.
Let
kate
answer
as
well
and
so
the
medically
certified
translators.
This
is
what
is
required
if
you're
in
a
clinical
setting.
So,
for
example,
if
you
work
in
a
hospital,
although
you
might
be
a
native
speaker
of
a
language
you're
not
allowed
to
translate,
unless
you
have
that
certificate
of
translation
that
you've
taken
the
courses
and
passed
the
test.
So,
for
example,
I'm
conversational
spanish,
but
I'm
not
fluent
spanish
and
I'm
not
a
certified
translator.
E
So
when
you're
in
those
clinical
settings,
most
of
them
will
have
a
1
800
number
that
you
can
call
to
get
access
to
translation
services,
and
that's
all
verbal.
That's
the
piece
that
we
were
talking
about
with
the
aca
and
the
civil
rights
act
that
most
of
that's
been
translated.
As
that
verbal
piece.
E
That
that's
what
we
mean
by
the
medically
certified
and
the
third
parties,
and
the
word
as
terms
of
responsibility
for
not
having
accurate
translation
I'll.
Let
miss
ballard
talk
about
what
medical
translation
looks
like
specifically,
but
I
will
say
that
having
ongoing
conversations
with
the
justice
association
and
we're
gonna
hear
testimony
from
them
about,
I
think
parody
and
liabilities
around
verbal
translation
and
then
this
bill,
which
does
a
written
translation
and
their
arguments
for
why
the
written
translation
ought
to
be
have
the
same
protections
as
verbal
translation
but
I'll.
F
Thank
you.
Thank
you
for
your
question.
Vice
chair
carlton,
for
the
record,
my
name
is
kate
ballard.
So
as
for
the
accuracy
of
the
translations,
and
in
my
testimony
I
did
go
over
kind
of
the
step-by-step
process,
but
to
address
your
question
more
specifically,
the
differences
in
dialect
should
be
identified
in
that
vetting
process
where
it's
reviewed
by
independent
groups
and
independent
individuals
and
where
one
translation
is
created.
F
That
vetting
process
is
then
reviewed
by
an
independent
group
of
individuals,
and
so
hopefully,
at
that
point
those
dialects
or
slight
differences
across
geographies
would
be
weeded
out
now.
This
is
the
same
kind
of
rigorous
process.
That's
already
used
for
verbal
communications
as
well,
and
so
I
hope
that
kind
of
answers.
Your
question
about
differences
in
dialects.
I
will
as
well
say
that
we've
learned
that
sometimes
differences
in
dialects
aren't
reflected
in
writings,
and
so
that
kind
of
varies
as
well.
Does
that
answer
your
question.
G
And
thank
you
very
much,
madam
chair.
If
I
could
just
quickly
follow
up
when
the
conversation
about
the
software,
so
since
the
majority
leader
leaders
getting
so
many
different
opinions
on
what
the
software
is-
and
this
has
been
done
in
your
state,
mrs
miss
ballard,
do
you
happen
to
know
how
much
the
software
costs
the
pharmacies
in
your
state?
Were
you
able
to
ask
any
of
them?
What
the
real
cost
of
doing
business
is.
F
Yes,
so
vice
chair
carlton,
it
varies
widely,
as
was
mentioned
before,
depending
on
the
kind
of
software
that
the
pharmacy
or
healthcare
system
already
has
for
chain
pharmacies
that
have
multiple
locations
and
very
complex,
expensive
software
that
they
already
have.
It
can
be
more
expensive
to
integrate
it.
However,
one
large
hospital
system
in
oregon,
it
costs
them
twenty
five
thousand
dollars
to
translate
one
thousand
cigs
and
have
it
automated,
like
an
automated
process,
set
up
where
it
automatically
pulls
what
language
the
english
speaks
from
the
chart.
F
It
doesn't
even
have
to
be
requested
and
then
spits
out
a
translated
label
that
cost
for
1
000
directional
phrases
was
25
000,
however,
for
an
independently
owned
pharmacy
in
oregon
that
provided
translated
labels
before
the
even
law
law
went
into
effect
for
14
languages,
it
cost
them
70
a
month,
and
then
there
was
another
company
in
oregon
that
would
provide
a
hundred
cigs
in
one
language
for
a
250
one-time
payment.
Those
are
just
kind
of
some
of
the
examples.
A
F
Thank
you
for
your
question
shareholding.
I
wish
I
had
more
hard
data.
It
has
only
been
three
months
since
the
law
took
effect,
and
so
unfortunately
I
don't
have
the
kind
of
hard
data
compiled,
but
I
will
say
that
in
my
personal
opinion,
as
a
nurse,
I
feel
much
more
confident
now
being
able
to
discharge
a
patient
from
the
hospital
with
a
label
that
they
can
read.
E
He
if
I
could
respond
so
I
imagine
that
the
data
will
follow
because
there's
the
federal
language
law
and
mandate
we
are
just
starting
to
see.
I
think
what
is
a
very
exciting
movement
around
language
equity
in
this
space
start
starting
to
have
these
conversations
about
the
health,
information
and
prescriptions,
and
so
you'll
notice
that
in
my
opening
testimony,
I
think
I
referenced
five
or
six
studies
and
I'm
talking
with
the
committee
manager.
E
Some
of
them
are
copyrighted
because
it
would
have
been
much
easier
for
me
just
to
present
them
as
exhibits
and
put
the
data
information
your
hand,
but
because
of
some
copyright
issues.
I
needed
to
cite
all
the
sources
in
my
testimony,
but
there
are
five
different
studies
regarding
adverse
drug
effects
and
the
link
to
language.
E
There
are
so
many
studies,
chairwoman
and
and
I've
been
working
with
your
committee
manager,
about
which
ones
that
we
can
make
sure
live
in
exhibits
and
then,
which
ones
are
going
to
have
to
be
paper
copies
that
are
circulated
for
you,
books.
D
Thank
you,
madam
chair,
for
the
question
and
thank
you
majority
leader
for
the
presentation.
So
my
question
is
what
currently
happens
for
non-english
speaking
patients.
You
know,
like
you
go
into
the
pharmacy
and
usually
the
pharmacist.
Will
you
have
a
little
consultation
and
they
explain
it
or
whatever
so
like
what
happens
currently?
Do
they
if
they
can't
communicate
with
them
or
they
just
hand
them
their
bag
and
off
they
go.
E
Thank
you,
assemblywoman
hardy,
that's
a
great
question
and
no
the
the
pharmacists
in
our
state.
They
do.
I
will
say
this:
if
you've
ever
walked
into
a
pharmacy.
You've
never
seen
a
pharmacist
sitting
down,
they
are
so
busy
and
they
are
doing
so
much
and
I
know
they
care.
So
no.
I
don't
believe
that
they
would
just
kind
of
hand
a
bag.
They
are
required
in
that
setting,
while
they're
at
the
pharmacy
to
have
translation
services,
so
they
will
have
a
1
800
number
available
so
that
they
can
translate
at
that
time.
E
With
that
person
where
this
bill
becomes
important
and
where
the
difference
is
is
once
they
walk
out
that
door
and
once
they're
in
their
home
setting,
they
are
left
with
nothing
in
their
own
language
and
and
without
the
ability
to
have
translation
services
at
hand,
and
so
that's
that's.
The
distinction
that
we're
trying
to
get
is
making
sure
this
information
follows
the
patient
into
their
into
their
home.
Setting.
D
And
then,
if
I
just
one
quick
follow-up,
if
that's
okay,
yes,
please
thank
you,
and
so
I
understand,
like
you,
mentioned
several
states
that
are
starting
to
do
this,
but
is
this
bill
based
pretty
much
off
the
oregon
one?
Is
that
right.
E
Ideally,
and
if
it
were
the
will
of
the
committee,
I
would
love
to
see
more
information
translated,
but
I
I
think
that
it
sounds
so
simple,
but
I
think
if
we
get
just
the
label
done,
we
are
in
a
great
place
for
our
citizens,
and
so
that's
how
it's
a
uniquely
nevada
bill,
and
I
have
to
say
I
felt
this
bill
came
to
me
because
I
was
talking
out
loud
over
the
summer
with
some
friends
about
the
frustration
of
the
role
that
I
had
as
a
professional
social
worker
in
the
medical
field,
working
in
people's
homes
and
feeling
like
I,
I
was
not
serving
them
best
because
we
have
so
many
language
issues
and
someone
said
well,
you
know
it
doesn't
have
to
be
that
way.
E
They've
done
something
about
it.
In
oregon
and
and
california
did
something
a
year
a
couple
years
ago,
so
we
got
in
touch
with
oregon.
So
I
don't.
I
don't
want
anyone
to
think
that
this
was
me
raising
my
hand,
saying
hey.
I
want
to
do
something,
that's
done
outside
of
nevada
and
bring
it
here,
because
you
guys
know
me,
that's
not
me,
I'm
the
first
one
to
say
well,
if,
if
florida
jumped
off
a
bridge
to
nevada
jump
off
a
bridge,
I
mean
that's
kind
of
classic
me.
D
Thank
you
for
that
explanation.
Thanks.
H
Thank
you
chair.
You
caught
me
off
guard
there
for
a
second
I
want
to
I
this
goes
to,
I
think,
miss
ballard.
I
need.
I
just
want
to
clarify
it's
sort
of
building
upon
what
vice
chair
carlton
said.
Did
you
say
that
the
liability
for
the
translations
is
assumed
by
the
pharmacy
and
not
the
translating
company.
F
H
As
if
section
5
is
now-
and
I
agree
with
you-
that's
the
way
it
should
be-
the
liability
should
be
the
person
that
did
the
work.
So
I
appreciate
that
clarification
for
me
also
in
oregon.
You
said
it's
only
been
three
months,
so
you
probably
can't
answer
this,
but
did
this
increase
costs
of
any
of
the
medications?
Now
I
mean
we
already
complained
about
the
ex
high
cost
of
medications.
F
Thank
you
for
your
question.
No,
not
that
I've
observed
there
has
been
no
increasing
cost.
I
know
that
it
was
intended
by
the
champions
and
the
senators
and
representatives
in
oregon
who
championed
the
bill
to
ensure
that
it
did
not
raise
the
cost
of
medications
and
the
pharmacies
that
we
worked
with,
and
various
stakeholders
throughout
that
process
ensured
that
that
would
not
occur.
I
can't
speak
for
nevada
specifically,
but
I
would
imagine
that
it
will
not.
H
H
No,
that's
fine
that
wasn't.
The
question,
though
I
just
want
to
you,
know
we're
all
here
and
I
really
appreciate
I
like
the
intent
of
this
bill,
because
we're
really
here
for
the
betterment
of
our
citizens
and
to
improve
health
care,
and
this
is
one
ass
aspect
of
health
care,
improving
health
care
and
I
think
it's
an
excellent
bill
to
do
that.
And
I
appreciate,
as
I
said,
are
miss
benitez
thompson
bringing
this
forward
and
you
were
explaining
it.
E
Thank
you
so
much.
I
can
respond
to
that
assemblyman,
oh
neil,
so
though
we
have
fcqc
that
does
this
locally
and
the
that
pharmacist,
it's
a
click
of
a
button.
H
C
Thank
you,
madam
chair,
and
thank
you
for
the
presentation.
I'm
really
glad
to
see
this,
but
I
just
wanted
to
kind
of
ask
a
question
that
I
I
think
other
people
were
maybe
trying
to
get
to,
or
maybe
I
was
just
going
there
myself
is.
I
understand
the
lives
and
the
health
that
you
know
that
is
being
saved
by
being
able
to
look
at
your
prescription,
bottle
and
read
it
in
your
own
language
and
make
sure
that
you're
taking
it
the
correct
way.
C
So
I
can
see
the
savings
there,
but
just
in
the
three
months
since
oregon
has
started
this
law,
have
there
been
any
pharmacies
that
refused
to
do
this
or
closed
down
or
you
know?
Was
this
any
kind
of
a
significant
force
to
stop
or
essentially
are
people
able
to
do
this
and
you
know
to
help
folks
get
their
prescriptions
and
be
able
to
read
them.
F
So
far,
I've
personally
seen
good
success
with
pharmacies
in
oregon
in
oregon.
The
the
oregon
board
of
pharmacy,
while
we
were
creating
this
bill,
said
that
the
way
that
they
approach
compliance
is
that
they
don't
take
a
punitive
approach.
Instead,
they
try
to
work
with
pharmacies
toward
compliance
understand
what
the
obstacles
they
face
are
now,
so
that's
kind
of
the
approach
that
they
take.
F
As
for
nevada,
I
I
can't
speak
specifically
for
the
board
of
pharmacy
there
and
I
will
add
as
well
that
independently
owned
pharmacies
typically
face
more
conservative
costs
in
the
face
of
this
bill.
Does
that
answer
your
question
adequately?
C
But
you
haven't
seen
any
pharmacies
closed.
It's
just
a
matter
of
maybe
there's
a
time
to
ramp
up
or
to
get
accustomed.
F
E
And
if
I
could
add
a
piece
there
as
written
right
now
in
section
two,
the
effective
date
is
upon
passage
and
approval.
E
I
would
be
more
than
willing
to
talk
with
stakeholders
about
the
regulation
part
and
how
the
regu,
because,
typically
we
could
say,
passage
and
approval
starting
the
regulations
and
then
giving
a
year
for
all
of
that
to
happen,
and
then
the
the
time
to
start
where
the
pharmacies
have
to
take
action.
I
don't
know
that.
Quite
honestly,
we've
been
in
a
place
with
conversations
where
we've
gotten
to
section
two,
but
that
is
something
that
we
want
to
be
sensitive
to
to
the
concerns
about
yeah.
E
I
Thank
you
chair.
I
I
the
I
love
all
the
the
explanation
and
and
the
presentation
and
how
it
would
be
helpful
for
everybody,
and
I
can
certainly
see
that,
and
so
it
was
interesting
for
me
to
learn.
I
didn't
realize
that
if
somebody
goes
into
a
pharmacy
right
now
in
the
state
of
nevada,
there
is
an
online
translation
services.
Is
that
correct
if
they
need
help
with
translating
the
prescription.
E
A
phone
it's
a
phone
call.
Yes,
that's
what
I
thank
you
for
clarifying
assemblywoman
casama,
so
when
you're
in
there,
when
you're
in
the
setting-
and
you
were
talking
with
your
pharmacist-
if
you
were
not
language
proficient
the
pharmacist,
her
aca
and
civil
rights
would
call
a
translator
to
have
a
conversation
with
you.
I
I
see
so,
but
the
person
that
is
getting
the
prescription
translated
they
can
take.
They
can
take
notes
as
in
their
language
as
to
what
should
be
done
and
they
can
go
home
with.
F
That
they
could
perhaps
do
that,
although
in
my
practice
I
have
not
seen
that
done,
sometimes
in
person,
interpreters
are
willing
to
write
out
translations,
but
that
is
dependent
on
the
individual's
preference.
I
will
also
say
that
now,
especially
during
covid
times
I
have
seen
there
has
been
a
huge
increase
in
virtual
or
phone
interpreters
being
used,
and
so
it's
it
would.
The
interpreter
would
not
be
there
to
write
things
down
for
them
and
orally.
F
I
And
I
I
can
see
that
that
it
might
be,
you
know
better
to
have
it
written,
but
I'm
just
concerned
about
the
cost
that
goes
to
these
pharmacies
and
the
requirements,
and
I
know
my
my
parents
were
immigrants
and
didn't
speak
english
and
they
had
a
lot
of
trouble
with
with
things
like
this
and
renting
a
house
and
forms,
and
but
they
got
help
from
the
community
and
they
rallied
and
it
wasn't
easy,
but
it
is
some
of
the
steps
that
they
took.
So
I'm
I
understand
the
intent.
C
Thank
you
so
much
chair
and
and
thank
you
majority
leader
for
bringing
this
discussion
forward.
Certainly,
communication
is
key
and
and
making
sure
that
people
understand
what
it
is
they're
taking
is
so
important
for
all
the
reasons
you
outline,
but
I'm
wondering,
if
has
the
pharmacy
board,
had
a
chance
to
review
this
language
and
maybe
run
it
by
their
members
and
get
feedback
because
we
are
hearing
so
many
different
levels
of
estimates
of
cost
or
questions
around
implementation.
E
Thank
you,
assemblywoman
told
us.
I
believe
they
are
on
the
call
so
I'll.
Let
them
represent
for
themselves.
J
C
Sure
I
just
wanted
to
see
if
you
had
any
input
as
you've,
maybe
consulted
with
other
pharmacy
boards
and
other
states
that
have
implemented
this.
How
how
the
implementation
was,
how
you
envision
the
implementation
here
in
nevada
and
and
what,
if
you've
surveyed
the
members
in
nevada
what
the
costs
will
be
just
just
so
we
can
get
a
more
clear,
overarching
answer.
J
So
I
am
I'm
obviously
familiar
with
the
bill.
The
concept
of
the
bill
would
be
people
able
to
communicate
with
each
other,
of
course,
is
the
right
way
forward.
We
want
people
to
understand
the
pharmacists,
do
have
an
obligation
to
counsel
the
patients
and
so
yeah.
They
use
several
different
mechanisms,
one
of
which
would
be
like
telephone
translators
and
that
kind
of
thing
the
bill
in
oregon
is
relatively
new.
J
C
Thank
you
follow
up,
madam
chair
never
told
thank
you
and
I
I
appreciate
that
and
again
I
love
the
intent,
and
I
hear
the
concerns
also
and
I'm
wondering
if
there's
a
way
to
consolidate
and
and
perhaps
I
can
take
this
offline
with
the
sponsor
a
way
to
to
accomplish
this
task
in
a
way
that
that
will
help
with
the
cost
saving
concerns
of
just
having
a
consolidated
one
statewide
source,
where
you
could
get
that
translation
printed
out
from
the
state
and
and
still
accomplished
the
same
goal
that
we're
trying
to
accomplish
here.
C
A
Thank
you,
assemblymember
tolls,
I'm
going
to
come
to
assemblymember,
dickman
and
some
member
dickman.
I
just
want
to
remind
you
that
we
still
need
to
go
to
testimony
and
we
have
another
bill
to
hear
and
we
lose
members
at
4
p.m
to
another
committee
meeting.
So
if
you
could,
please
make
it
okay.
B
Thank
you
so
much.
I
I'm
still
on
the
liability
just
a
little
bit.
I
know
we
touched
on
it
and
I
believe
the
majority
leader
said
you're
still
kind
of
working
on
that.
But
currently,
if,
if
you
get
your
prescription
in
english
and
it's
incorrect,
you
have
some
recourse.
B
E
You
so
much
for
the
question:
assemblywoman
dickman,
so
you're
going
to
hear
from
the
nevada
just
association
later
right
now
in
opposition
because
of
that
of
that
section
in
section
5.
they
they
obviously
know
law
and
liability
more
than
than
I
do,
and
we've
been
able
to
talk
a
little
bit
and
it's
my
understanding,
they're
going
to
talk
a
little
bit
about
the
parity
that
they
would
be
seeking
between
verbal
translation
and
then
written
translation,
and
it's
an
it's
an
argument
that
I'm
I'm
open
to.
E
So
I
would
say
it's
time
it's
it's
that
why
liability
is
a
work
in
progress.
Okay,.
B
Thank
you
chair,
so
the
question
I
have
is
that
this
would
be
most
most
helpful
and
useful
so
that
you
could
go
home
and
read
the
information
from
your
prescription
in
the
privacy
of
your
home.
I
mean,
I
think
our
prescriptions
are
very
private.
We
don't
want
everybody
to
know,
so
I
wouldn't
really
want
to
take
it
to
my
neighbor
and
let
them
know
what
my
medical
needs.
Some
things
are
very
private,
so
by
them
being
able
to
take
this
home,
this
would
make
it
more
private
and
very
useful.
B
Wouldn't
it
majority
leader.
E
Thank
you,
assemblywoman
martinez,
I'm
I
mean
absolutely,
I
think
people
my
experience
has
been
is
that
patients
don't
want
to
do
one
main
thing,
which
is
appear
to
be
a
burden
to
their
family
and
or
appear
to
be
a
burden
at
all,
and
so
this,
this
kind
of
manifestation
of
toughness
means
we
don't
often
ask
questions
or
ask
for
help,
and
so
I
I
think
that
there's
well,
I
don't
necessarily
have
data
on
it.
E
I
think
that
there
is
a
sensitivity
to
what
some
of
these
prescriptions
are
and
that
people
would
rather
be
able
to
of
limited
english
proficiency,
be
able
to
read
them
and
then
better
manage
and
be
in
charge
of
their
own
health
care,
because
they're
empowered
by
the
simple
in
active
reading
the
information
in
a
language
that
they
can
understand.
A
Thank
you,
assemblymember
martinez,
and
with
that
we
are
going
to
move
into
the
testimony
portion
of
our
bill
hearing.
I
just
want
to
let
everyone
know,
because
we
still
do
have
another
bill
to
hear
after
this
and
I
lose
members
to
the
4
pm
committees.
I
will
be
limiting
testimony
on
both
bills
to
30
minutes
in
each
category.
So
30
minutes
in
support
30
minutes
in
opposition
30
minutes
in
neutral,
and
with
that
I
will
go
to
support
of
assembly
bill
177.
A
K
Hello,
thank
you,
madam
chair,
for
the
the
opportunity
today
to
testify.
For
ab177
my
name
is
amy
ku
a-m-y-k-o-o
and
I
am
the
deputy
political
director
with
one
apia
nevada.
I
first
want
to
thank
assemblywoman
benitez
thompson
for
centering
language
access
and
health
equity.
Nevada
is
home
to
over
300
000
asian
pacific
islander
americans,
comprising
about
10
of
the
total
population.
K
We
focused
on
the
issues
that
affect
our
livelihood,
including
language,
access
and
healthcare
as
the
fastest
growing
community
in
nevada.
We
are
aware
that
the
infrastructure
to
support
the
community
in
tangible
ways
is
lacking.
I
myself
have
been
a
translator
for
my
parents
for
as
long
as
I
can
remember.
Like
many
second
generation
children,
my
parents
relied
on
me
to
fill
a
gap
in
language
access
in
our
institutions.
When
my
parents
would
have
changes
in
medication
or
need
to
read
dosage
instructions,
they
relied
on
me
to
ensure
that
they
were
taking
it
correctly.
K
There
are
currently
approximately
300
000
limited
english
proficient
nevadans,
who
are
also
facing
these
barriers
to
health
care
for
new
immigrants
and
mixed
fluency.
Households
having
prescription
instructions
in
both
english
under
native
language
is
a
critical
step
to
ensuring
healthcare
parity
for
all
negatives
currently
about
one
in
one
out
of
five
emergency
room
visits
is
due
to
a
preventable
medication
error.
One
case
of
a
mistaken
medication
can
cost
up
to
ten
thousand
dollars
in
hospital
fees
in
new
york
state.
K
Where
a
similar
translation
bill
for
prescription
labels
was
passed
in
2012,
we
saw
that
from
2006
2015.
There
was
an
increase
in
pharmacies
that
reported
translating
labels
daily
from
15.4
in
2006
to
66.7
in
2015..
This
is
a
great
opportunity
to
advance
language
justice
in
nevada.
Ab-177
is
a
cost-effective
and
critical
step
to
ensuring
that
all
nevadans
have
health
care
parity.
Thank
you.
K
K
A
couple
key
findings
from
that
research
was
where
the
lack
of
good
communication
and
translations
that
create
an
additional
barrier
to
care
and
increases
the
burden
of
disease
in
nevada,
also
using
online
translation
tools
like
google
translator,
don't
always
translate
things
correctly
and
therefore
are
not
reliable
for
translation
from
english
to
spanish
or
any
other
language
for
that
matter
and
creating
more
disparities.
So
with
that
being
said,
I
support
this
first
language
health
services,
because
this
is
a
simple
change
that
can
be
that
can
really
create
a
huge
and
positive
impact.
K
According
to
2019
nevada,
state
health
needs
assessment.
Over
30
percent
of
nevada's
population
is
latinx
and
is
a
population
that
continues
to
increase
the
most
so
for
many,
english
is
their
second
language.
In
addition,
the
immigrant
share
for
the
population
is
near
a
historic
high.
According
to
the
pew
research
and
nearly
half
have
limited
english
proficiency
or
the
ability
to
speak
english
and
very
not
very
well,
this
bill
would
not
be
duplicating
any
other
health
services
where
creating
other
health
services
would
be
more
expensive
and
staff
intensive.
K
You
know,
there's
many
different
disparities
among
the
latinx
communities,
one
being
translating
to
is
too
technical,
and
sometimes
too
risky
for
family
and
members
and
friends
and
like
many
children,
are
the
translators
for
their
parents,
and
children
should
not
have
to
be
relied
on.
To
read
prescriptions,
I
mean
prescriptions
can
be
challenging
just
in
english
right,
so
other
types
of
health
and
navigator
services
would
also
be
more
expensive
and
are
not
24
7.
You
know
so
nurse
navigators,
community
health
workers
and
so
on
so
forth.
K
So
this
would
really
make
a
big
difference.
Health
and
language
equity
is
really
important.
Everyone
has
a
right
to
be
served
in
their
first
language.
Reading
prescription
labels
again
is
challenging
enough,
and
I
cannot
imagine
trying
to
translate
my
medication
from
one
language
by
not
confident
in
and
trying
to
basically
consume
that
as
well.
Thank
you.
L
Yeah.
Thank
you,
madam
chair
members
of
the
committee.
For
the
record.
My
name
is
barry
gold
with
aarp
nevada.
This
appears
to
be
a
very
simple
public
policy,
but
this
has
and
will
have
a
huge
impact
on
improving
public
health.
Many
of
you
have
heard
me
use
the
old
saying
that
life-saving
drugs
do
not
work.
If
you
can't
afford
to
take
them.
You
could
also
say
life-saving
drugs.
Do
not
work
if
you
don't
know
what
they
are
or
how
to
take
them.
L
L
Well,
you
know
what,
if
you
can't
read
what
that
label
says
that
isn't
going
to
help
you
so
individuals,
family
members
and
caregivers,
who
often
assist
people
with
taking
their
medicine.
Medicines
really
need
to
be
able
to
understand
what
the
prescription
drugs
are
and
how
to
take
them.
Now
we
heard
earlier
that
the
average
person
takes
about
five
prescription
drugs.
If
you're
going
to
talk
about
older
adults,
it's
very
often
they
have
10
or
more
prescription
drugs.
L
L
So
aarp
nevada,
on
behalf
of
the
345
000
members
across
the
state,
strongly
strongly
support
the
passage
of
ab177
that
is
really
going
to
help
nevadans
have
better
health
com,
health
outcomes
if
they
are
just
able
to
read
their
prescription
bottles.
Thank
you
very
much.
A
A
B
B
B
B
We
are
supportive
of
efforts
to
make
prescription
drug
labeling
more
accessible
to
the
low-income
community
members
that
we
serve,
who
often
times
primarily
speak
a
language
other
than
english.
This
still
aligns
with
our
consumer
protection
goals,
to
ensure
that
people
have
meaningful
access
to
the
important
information
that
they
need
to
make
critical
decisions.
Thank
you.
B
B
B
B
B
Good
afternoon,
chair
and
the
committee,
this
is
dora
martinez,
I'm
representing
the
nevada
disability
peer
action
coalition,
and
I
am
in
support
of
av-177,
and
I
would
like
to
emphasize
on
the
population
who
are
american
sign
language
speakers
and
just
to
be
aware
that
they
do
not
read
english
as
the
first
language
is
asl.
So
just
so,
you
guys
are
aware
and
put
that
in
there
somewhere
to
have
equal
access
to
medication.
A
M
Hi,
madam
chair,
thank
you
for
for
the
opportunity
to
testify
today.
My
name
is
yin
wing,
I'm
health,
navigator
of
asian
community
development
council.
I
lived
in
vega
for
seven
years
and
I
work
for
vietnamese
community
across
the
state
to
enroll
in
health
insurance.
This
is
I'm
testifying
in
support
ab177.
M
As
we
know,
there
are
68
000
limited
english
households
across
the
state.
Hcdc
is
the
partner
of
navada
housing
and
we
have
bilingual
staff
in
tangaroa,
vietnamese,
chinese
and
spain
and
spanish.
We
are
passionate
about
healthcare,
poverty
and
language
assets.
I
talked
to
my
client
about
their
ex
care
and
vietnamese
client
preferred.
A
Looks
like
we
might
have
lost
you.
Can
you
hear
us?
Yes,
yes,
okay,
please
continue
and
if
you
also
have
your
statements
in
writing,
please
feel
free
to
share
them
with
our
committee
manager.
So
she
can
make
sure
the
committee
members
receive
them.
Since
we
are,
you
are
cutting
in
and
out.
M
Okay,
in
in
case
some,
some
of
the
small
vietnamese
communist
community
life
spa,
they
have
to
travel
or
use.
The
google
translate
to
read
asian.
M
Oh
I'm
so
sorry,
maybe
our
internet
is
not
good.
I
will
I
will.
I
will
send
information
by
the
trust.
It's
okay
with
you.
I
will
reply.
The
email.
A
N
Good
afternoon,
madam
chair,
can
you
hear
me
I
can
thank
you
for
being
here.
Thank
you,
and
I
appreciate
the
opportunity
that
I've
been
given
to
speak
on
ab177,
and
I
thank
the
sponsor
for
the
work
that
we've
done
so
far.
Rand
is
proud
to
represent
many
of
the
community
pharmacies
in
nevada.
A
pharmacist
is
one
of
the
top
three
most
trusted
professions.
For
many
years
now,
they're
accessible
to
patients
and
taking
care
of
the
patient
is
something
they
take
very
seriously.
N
N
Community
pharmacies
stand
ready
to
serve
our
community
health
needs
daily
and
during
times
of
emergency,
these
pharmacies
include
the
traditional
drug
stores,
the
supermarkets,
the
mass
mass
retailers
mass
merchandisers
that
have
pharmacists,
as
well
as
our
independents,
which
we
have
willfully
few
of
in
nevada,
rand
members
believe
in
including
every
citizen
or
group
or
community
in
nevada,
in
in
taking
care
of
their
health
care
needs
hold
on.
I'm
sorry,
let
me
let
me
get
this.
N
Ab177
seeks
to
mandate
pharmacies
print
two
different
labels
and
fix
these
labels
to
the
prescription
drug
models,
one
which
must
be
in
any
language
requested
by
a
customer
at
this
point.
At
this
point
in
time,
the
language
reflects
that
the
members
understand
the
need
of
the
communities
that
this
bill
intends
to
assist
and
have
been
working
for
years
to
try
to
provide
such
service
for
them.
Retail
pharmacies
recognize
that
not
all
customers
are
fluent
or
prefer
to
use
english
in
their
daily
lives,
because
the
primary
language
of
medicine
is
english.
N
N
Anyone
can
call
this
number
at
any
time.
Any
family
member
within
the
home
is
has
access
to
this
number
to
get
the
translation.
If
there's
no
understanding
and
the
patient
had
can
call-
and
it
is
a
24
7
number,
there
is
always
someone
there.
We
have
some
trends,
we
have
the
same
translators
as
hospitals
and
we
provide
it
outside
of
clinical
settings.
Also,
public
health
and
pharmacies
have
a
strong
history
of
reaching
mutual
public
health
goals
together
for
the
benefit
of
all
patients
in
our
state.
N
We
appreciate
the
sponsor
adding
the
third
party
liability
to
the
language
and
removal
of
that
language
would
raise
even
more
concerns
for
our
members.
At
this
time,
we
would
like
the
opportunity
to
work
with
the
sponsor
of
the
bill
and
to
improve
services
to
every
community
in
nevada,
specifically
the
minorities
and
those
with
limited
english
speaking
skills.
N
Rand
believes
we
need
to
have
further
discussions
with
stakeholders,
as
we
have
concerns
and
and
oppose
the
language
as
it
is
written
today,
we'd
like
to
thank
the
sponsor
again
for
engaging
those
in
the
industry
and
look
forward
to
working
with
her
as
we
go
forward,
and
I
would
be
happy
to
answer
any
questions.
N
A
A
A
O
We
think
it's
a
good
bill
and
we
think
it
establishes
good
public
policy,
but
we
do
have
some
difficulties
with
the
immunity
provision
set
forth
in
paragraph
or
section
5
of
the
bill
and
therefore,
as
a
formality,
we're
opposed
to
it
as
as
the
bill
is
presently
set
forth.
We
would
be
fully
supportive
of
the
bill
if
it
was
amended
and
amended
in
the
matter
of
removing
section
5.
The
liability
section
immunity
is
a
difficult
concept
for
the
justice
association,
particularly
in
view
of
last
special
session,
where
huge
grants
of
immunity
were
established.
O
Immunity
restricts
access
to
the
court,
immunity,
undercuts,
holding
people
and
entities
fully
accountable
and
responsible.
If
you
excuse
people's
bad
conduct,
all
you
do
is
encourage
a
lack
of
diligence
and,
lastly,
immunity
has
unintended
consequences
in
this
bill.
If
you
leave
the
immunity
provision
in
you,
establish
two
sets
or
two
classes
of
individuals,
those
who
speak
english,
who
don't
have
to
deal
with
any
immunity
issues
and
those
who
don't
speak
english,
who
then
have
to
deal
with
an
immunity
issue
from
a
constitutional
law
perspective.
O
I
think
that
raises
unintentionally
an
equal
protection
consideration
or
equal
protection
argument.
We
appreciate
the
conversations
with
the
sponsor
of
the
bill.
We
appreciate
the
opportunity
to
continue
to
work
with
the
sponsor
of
the
bill
and
we're
hoping
that
the
amendment
that
we
we
have
suggested
again,
eliminating
section
five
will
be
considered
and
that,
ultimately,
our
opposition
will
turn
into
a
position
of
support.
Thank
you,
madam
chair
members
of
the
committee.
A
B
G
G
We
know
we
have
limited
time
to
testify
in
our
opposition,
but
we
did
submit
a
letter
detailing
our
opposition
and
share
some
of
the
same
concerns
that
were
outlined
by
our
colleagues
at
the
retail
association
of
nevada.
While
this
bill
is
well
intentioned
and
recognizes
our
increasing
diversity
and
appreciation
for
its
growth,
we
pose
this
bill
due
to
its
stringent
burden
on
pharmacies
and
those
employees
who
want
only
to
assist
their
customers
in
an
efficient
manner.
Thank
you,
chair
and
committee
members
for
your
time.
B
P
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
I
apologize,
I
was
having
a
connection
issues
so
apologize
for
dropping
on
video.
The
chamber
does
have
concerns
with
the
bill,
as
proposed
on
behalf
of
our
members,
who
have
directly
been
impacted
by
these
proposed
changes.
We
agree
that
prescriptions
should
be
available
in
other
languages,
if
requested
by
the
customer.
P
However,
as
you've
heard
from
my
colleague
from
the
retail
association,
pharmacies
do
print
instructions
in
a
variety
of
languages
and
offer
customers
further
assistance
with
the
1-800
language
helpline.
We
are
concerned
about
the
cost
that
would
be
associated
with
the
requirement
to
print
two
labels
on
prescriptions,
logistical
challenges
and
the
implementation
of
such
a
program.
P
We
would
have
grave
concern
about
removing
limits,
removing
liability
protections
that
have
been
discussed
today
with
that
said
that
we
will
make
the
commitment
to
work
with
the
spill
sponsor
to
find
a
solution
that
will
help
address
the
nexus
of
the
bill.
Thank
you,
madam
chair,
for
your
time.
Today.
B
P
B-R-Y-A-N-W-A-C-H-T-E-R
and
I
serve
as
the
senior
vice
president
of
the
retail
association
of
nevada.
I
appreciate
the
comments
of
those
who
came
before
me
and,
and
certainly
my
colleague
mcmenamin.
I
did
want
to
concentrate
on
an
area
of
topic
of
interest
that
had
been
brought
up,
which
is
really
oregon.
P
We
heard
from
the
board
of
pharmacy
representative
that
that
is
currently
still
in
its
implementation
stage,
and
I
want
to
stress
that
that
is
that
is
true.
This
bill
actually
hasn't
been
enforced
or
100
implemented,
yet
in
oregon.
The
reason
for
that
and
why
it's
taken
four
years
since
the
passage
of
the
bill
to
get
it
done,
is
because
what
the
current
requirements
on
that
bill,
and
certainly
what
ab177
requires
goes
far
beyond
what's
currently
available.
P
P
Now,
as
you
know,
that
that
is
a
cost
that
the
pharmacy
is
not
going
to
pass
on
to
the
patient,
but
it
is
a
cost
that
is
going
to
have
to
be
absorbed
into
the
cost
of
doing
business
for
our
local
pharmacies,
and
that
means
that
anytime,
we
have
an
increase
in
the
cost
of
business,
it
puts
pressure
on
employee
hours,
it
puts
pressure
on
operating
hours
and
it
certainly
puts
pressure
on
whether
or
not
that
location
can
remain
solvent
going
forward.
Do
we
expect
that
to
happen?
P
I
think
we
are
uncertain
because
we
don't
have
the
information
out
of
oregon,
but
it
is
certainly
something
that
we
are
seriously
taking
a
look
at.
I
also
do
want
to
emphasize
that,
right
now,
in
a
pharmacy
in
nevada,
you
can
get
printed
instructions
for
those
medications
for
all
the
languages
that
the
majority
leader
shared
on
her
screen
earlier.
That
is
something
that
we're
proud
of
and
highlighting.
P
The
fact
that
you
know
in
outside
the
clinical
setting
patients
have
access
to
a
1-800
certified
translator
that
can
help
them
understand
their
medication,
and
this
is
especially
important
because
there
are
some
terms
that
are
not
easily
translated,
for
instance,
on
infusion
drugs,
infusion
is
typically
not
a
phrase
that
can
be
easily
translated,
and
so
in
this
case,
it
actually
is
helpful
to
have
a
live
translator
who
could
help
walk
through
exactly
what
the
intent
of
that
is
and
help
that
patient
actually
get
the
medicine
the
proper
most
effective
way
they
can.
So.
A
Here,
you're
a
mute.
Thank
you.
I
just
had
a
long
dialogue
with
myself.
Thank
you,
mr
walker,
for
your
testimony.
Now
we
can
move
into
testimony
in
neutral.
I
don't
see
anyone
signed
up
to
testify
in
the
neutral
position
on
video
so
broadcast.
Can
we
please
check
the
telephone
line
for
those
wishing
to
testify
in
the
neutral
position.
B
A
E
I
would
thank
you
and
I
appreciate
it
so
one.
I
look
forward
to
the
continuing
work
with
the
stakeholders
that
we're
going
to
do
on
this,
with
working
with
the
retail
association
of
nevada,
with
working
pharmacists
with
working
with
pharmacist,
and
actually
it's
been
really
helpful
for
me
to
actually
talk
directly
with
number
of
pharmacists,
because
they
can
help
me
get
down
into
the
nitty-gritty
about
their
daily
operations
and
how
things
are
are
working,
and
so
that
has
been
one
of
the
most
helpful
things
in
this
bill.
E
There
are
just
two
pieces
on
the
record
that
I
think
I
might
ask
for
more
clarification
on
and
if
that
can
come
in,
writing
that's
fine,
but
I
think
we
heard
to
the
the
testimony
that
english
or
translation
services
are
available
everywhere
and
that
I
just
want
to
make
sure
that
that's
not
misrepresented
as
to
mean
that
if
you
you
have
a
service,
that's
readily
available
to
patients.
Pharmacies
have
the
ability
to
call
in
and
do
verbal
translations
there.
E
But
when
you
go
into
the
home
they
and
the
conversations
I
had
with
the
pharmacist.
They
have
the
1
800
number
in
the
pharmacy,
but
they
don't
they
don't
print
it
on
the
bottle,
and
so,
if
you're,
just
at
home,
with
your
medication
bottle,
you
are
left
with
unsure
about
how
to
call.
And
then,
if
you
do,
call
in
you've
got
a
person
with
limited
english
proficiency.
E
Reading
the
bottle
to
a
translator,
you
really
need
a
translator
between
the
two
languages,
otherwise
it
doesn't
work
to
have
to
call
into
a
translation
services
and
then
you're
reading,
something
in
another
language.
I
I
hope
you
get
what
I
mean
there,
but
that's
that's
kind
of
the
crux
of
when
you
have
that
phone
call
with
the
pharmacist
right
there,
the
pharmacist
speaking
in
in
english
and
then
the
person
translating
to
that
other
person.
E
If
you
just
call
in
you're
going
to
lose
some
of
that,
because
the
limited
english
proficiency
person
will
be
reading
a
label
back
to
a
translator,
the
other
thing
is:
is
that
was
mentioned
on
the
record
that
you
have
the
ability
to
get
all
of
your
prescriptions
printed
in
instructions
right
now,
and
so
I
think
I
want
some
clarification
on
that,
because
there
are
different
pieces
out
there.
This
bill
is
specific
to
639
2801,
which
is
the
label
on
the
bottle.
E
There
are
other
things
like
medication
guides
or
patient
inserts,
and
so
I'm
confused
about
what
is
available
in
other
languages,
but
I
will
say
that
it's
been
my
in
my
practice.
I've
never
come
across
those
and
there
might
be
a
chain
provider
or
one
pharmacy.
E
Who
has
the
ability
to
print
things
in
english
and
spanish,
because
most
pharmacies
do
can
do
english
and
spanish
right
now,
but
I
just
want
to
make
sure
they're
not
misrepresenting
that
they
can
do
print
a
label
in
that
additional
in
in
all
of
the
different
languages
that
that's
the
standard
across
all
pharmacy.
So
that's
I
just
want
to
make
sure
y'all
aren't
thinking
that
I'm
asking
you
to
have
a
big
policy
conversation
of
about
something
that's
already
out
there
and
happening.
E
E
Ultimately,
I
really
do
feel
like
this
is
the
right
thing
to
do,
but
I
know
the
right
things
to
do
can
come
at
a
cost
and
I
want
to
minimize
those
costs,
and
I
know
that
we
heard
testimony
that
oregon's
taken
a
while
to
implement,
but,
but
I
think
part
of
that
has
been
a
lot
of
generosity
to
give
an
along
implementation
time,
and-
and
so
I
want
to
be
considerate
of
the
implementation
time,
but
I
I
also
want
to
be
considerate
of
the
fact
too
that
at
some
point,
if
we're
going
to
do
this-
and
we
make
an
affirmative
public
policy
decision,
that
this
is
best
for
nevada
and
our
residents
and
the
health
care
system
overall,
we
kind
of
get
there.
A
D
D
The
kova
19
pandemic
highlights
the
need
to
reconsider
the
rules
that
limit
access
to
needed,
prescription
drugs
for
nevadans,
such
as
older
adults
and
people
with
underlying
health
conditions
during
a
declared
state
of
emergency
or
disaster
insurance
companies
generally
impose
strict
limits
on
the
frequency
of
medication
refills
outside
of
times
of
crisis.
There
are
valid
reasons
insurance
companies
limit
when
and
how
much
of
certain
medications
people
can
obtain
at
one
time
they
could
be
misused,
misplaced
or
even
sold
on
the
black
mark.
D
Therefore,
many
people
obtain
a
one-month
supply
of
medicine
at
a
time
which
works
well
for
them.
One
year
ago,
to
facilitate
the
state's
response
to
the
19
pandemic.
The
governor
of
nevada
declared
a
state
of
emergency
nevadans
were
asked
to
limit
non-essential
activities
due
to
the
pandemic
and
were
encouraged
to
limit
their
trips
outside
their
homes,
to
gather
essential
items
such
as
food
and
prescription
medications
in
order
to
stay
safe
and
healthy.
D
So,
as
do
many
of
my
bills,
they,
the
genesis
for
them,
is
from
personal
experience
or
in
conversations
with
constituents.
So
I
actually
had
this
happen
with
my
own
mom.
She
takes
blood
pressure,
medication
and
she
needed
to
get
that
refill
and
at
the
time
she
was
uncomfortable
and
didn't
feel
she
wanted
to
go
to
the
doctor
and
also
wasn't
able
to
go
or
into
a
lab
so
that
she
could
get
that
refill.
D
Now,
she's,
very
independent
and
intelligent
and
usually
takes
care
of.
You
know
everything
that
she
needs
on
her
own,
but
this
took
a
little
bit
of
work.
Even
for
me,
we
had
to
go
through
several
loops
and
processes
in
order
to
get
that
medication.
For
her
experience
came
the
desire
to
bring
this
legislation
forward,
especially
during
the
coven
19
pandemic.
People
need
easy
access
to
their
medications,
which
may
be
difficult
during
times
of
social
distancing
and
their
ability
to
meet
with
health
care.
D
Practitioners
states
throughout
the
country
have
addressed
prescription
medication,
refills
in
times
of
natural
disasters
or
declared
state
of
emergency.
At
least
eight
states,
including
arizona,
california,
florida
maryland,
oklahoma,
south
carolina,
texas
and
washington,
allow
pharmacists
to
dispense
early
and
or
provide
refills
of
a
prescription.
Under
certain
circumstances.
D
D
Under
these
conditions,
the
commissioner
of
insurance
may
extend
the
time
periods
as
he
or
she
determines
necessary
to
respond
effectively
to
emergent
demands
during
a
state
of
emergency
or
natural
disaster.
The
public
may
need
increased
access
to
therapeutic
pharmaceuticals
meeting.
This
need
requires
safely
expanding
access
to
pharmacy
services
and
providing
temporary
and
limited
relief
from
certain
regulatory
restrictions
to
enhance
the
operational
capacity,
flexibility
and
efficiency
operations.
D
Currently,
a
pharmacist
may
refill
a
prescription
only
for
the
number
of
times
authorized
or
for
the
number
of
times
authorized
by
the
prescribing
practitioner.
Assembly.
Bill
178
creates
an
exception
to
this
rule
to
allow
a
pharmacist
to
fill
or
refill
a
prescription
in
an
amount
that
is
greater
than
the
amount
authorized
by
the
prescribing
practitioner,
but
does
not
exceed
a
30-day
supply
of
the
drug.
D
A
pharmacist
who
dispenses
drugs
under
these
conditions
is
required
to
issue
a
and
maintain
a
written
order
for
dispensing
the
drug
and
notify
the
prescribing
practitioner,
you'll
notice
on
nellis
the
fiscal
notes
from
the
department
of
business
and
industry,
the
department
of
health
and
human
services
and
the
state
board
of
pharmacy
indicate
there
will
be
no
fiscal
impact.
Most
of
the
local
governments
know
there
would
be
no
physical
and
fiscal
impacts
as
well,
so
in
closing,
ab178
helps
person
to
maintain
a
continuous
supply
of
medications
during
a
declared
state
or
of
emergency
or
disaster.
D
The
measure
also
authorizes
the
pharmacist
to
fill
or
re
refill
a
prescription
drug
to
a
person
living
in
an
area
that
is
declared
a
disaster
or
state
of
emergency
in
an
amount
greater
than
is
authorized
by
a
prescribing
practitioner,
but
does
not
exceed
a
30-day
supply
of
the
drug.
Under
certain
circumstances.
D
I
have
reached
out
to
and
have
been
working
with,
some
stakeholders
on
this
bill
and
I
value
their
input
and
will
continue
to
work
with
them
if
any
concerns
arise,
and
so
that
includes
concludes
my
remarks
and
mr
whis
from
the
board
of
pharmacy
is
here
answer
questions
and
then,
if
there's
anything,
specific
legal
questions
that
we
have
that
we
can't
answer
I'll
be
happy
to
get
those
answers
from
our
legal
staff.
Thank
you,
madam
chair.
A
G
Carlton
you
much
thank
you
very
much,
madam
chair,
so
assemblywoman
hardy
you
had
listed.
Who
was
in
this?
I
did
not
hear
self-insured
groups,
which
is
a
lot
of
folks
that
work
in
major
industry
in
las
vegas,
and
I
also
did
not
hear
through
a
health
and
welfare
fund
that
it
would
apply
to
them.
So
I
was
just
wondering:
could
you
repeat
the
list
or
clarify
if
those
two
are
actually
included
in
the
bill.
G
I
don't
believe
those
are
actually
in
there.
I
know.
Self-Insured
groups
are
not
under
the
jurisdiction
of
the
insurance
commissioner,
neither
or
as
the
health
and
welfare
unless
the
term
fraternal
that
you're
using
is
meant
to
aim
in
that
direction.
I
just
wanted
to
make
sure
that
if
you
were
trying
to
include
those
folks,
we
just
wanted
to
make
it
very
clear
that
they
would
be
included.
So
this
is
just
up
to
a
30-day
refill.
Then.
D
Right
correct
that
that
was
what
you
know
we
were
kind
of
thinking.
30
days
would
allow
someone
to
then
be
able
to
either
see
the
physician
or
maybe
set
up
a
telehealth
visit
or
something
like
that,
but
that
was
something
I've
been
working
with
with
folks.
If
you
think
there
should
be
another
greater
amount
of
days
or
whatever,
I'm
more
than
happy
to
work
on
that
it
was
just
something
I
felt
was
reasonable.
G
D
A
Thank
you
vice
chair
carlton,
and
I
just
I
just
have
a
quick
clarifying
question
assemblymember
hardy.
So
if
somebody
has
a
prescription
and
it's
a
30-day
prescription
and
they
have
one
refill,
they
get
their
prescription
today
and
then
tomorrow
there's
a
state
of
emergency.
They
can
immediately
get
their
next
30-day
refill.
D
The
way
I
I
would
understand
it-
and
this
may
be
a
legal
question-
I'm
not
sure,
but
if
they
have
a
refill
available
it
would
be
if
they're
don't
have
another
one
coming
up,
they
could
could
get
it
that's
the
way.
I
understand.
J
I
think
that
this
dave
lee's
for
the
record,
so
I
think,
there's
two
components
of
the
bill.
The
insurance
component,
which
nevada
law
would
already
allow
you've
already
put
in
place.
I
think
two
sessions
ago
where
people
could
get
a
larger
supply,
a
90-day
supply
as
long
as
it
wasn't
a
controlled
substance
and
that
they
had
it
filled
before.
That's
the
90-day
allowance
with
this
with
the
when
you're
talking
about
section
19.
J
J
This
is
more
comprehensive
bill
and
I
can
tell
you
that
for
the
past,
during
the
pandemic
early
on,
we
did
a
waiver
of
a
regulation
that
would
allow
pharmacists
to
do
this
during
the
emergency,
and
I
have
not
had
one
complaint
from
a
patient
or
a
doctor
that
somebody
got
the
med
that
they
shouldn't
have
gotten.
B
I
You
chair,
assemblywoman
party,
my
question
is,
you
know:
are
the
insurance
companies
okay
with
this
change,
because
I'm
sure
they
probably
have
a
policy
that
says
it
has
to
be
this
way
and
then
this
will
change
statute
and
has
that
been
run
by
them
that
they're?
Okay
with
this
or
this
is
above
my
pay
grade
or
if
this
changes
in
the
statute,
then
they
just
must
do
it
or
do
you
have
to
coordinate
with
them
to
you
know,
for
these
changes
just
curious
how
all
that
works.
D
Thank
you,
assemblywoman
melissa,
hardy
for
the
record.
I
have
not
heard
of
any
opposition
to
that
yet
but,
like
I
said,
we
have
been
working
with
stakeholders
and
would
address
those
concerns,
but
there
haven't
hasn't
been
any
anything
that
I
have
heard
in
that
regards
yet
so,
but
yes,
according
to
this,
that
you
know
they
would
be
required
to
pay
for
that
that
supply
that
refill.
C
Thank
you,
madam
chair.
I
have
a
question,
but
also
just
to
follow
up
on
vice
chair
carlton's
question
on
section,
or
I
guess
subsection,
two
of
each
section
talking
about
the
insurer
or
you
know
all
of
the
other
entities
that
would
be
taking
care
of
the
prescription.
It
says
the
commissioner
may
extend
the
time
periods
prescribed
by
subsection
one
in
increments
of
15
to
30
days
as
he
or
she
determines
to
be
necessary.
C
D
Thank
you,
assemblyman
constantine
for
the
question
melissa
hardy
for
the
record.
I
would
have
to
follow
up
with
that
with
the
commissioner,
unless
mr
reese
would
know
that
answer.
J
Yeah
dave
whis
for
the
record.
Thank
you
assemblywoman.
My
reading
of
it
is
that
those
sections
are
related
to
the
insurance
coverage,
and
so
yes,
the
commissioner,
would
be
able
to
extend
the
insurance
coverage.
I
think
most
insurance
covers
most
insurers
want
their
people
to
get
their
prescriptions
because
it
keeps
them
from
you
know
harm.
J
C
Thank
you
and
then
sheriff.
I
can
ask
one
more
question.
Yes,
thank
you
and
then
I
just
want
to
get
it
on
the
record
that
all
of
the
the
list
of
the
insurance
avenues
have
the
same
language
in
section
one
except
for
medicaid.
It
changes
a
little
bit
from
a
shell
to
a
may.
So
it's
my
understanding,
though,
that
the
medicaid
recipients
under
this,
this
change
shall
get
the
prescriptions,
even
though
the
wording
in
that
section
has
changed.
D
Thank
you,
assemblywoman
melissa,
hardy
for
the
record.
Yes,
I
did
ask
that
question
of
legal
and
they
keep
mr
sam
provided
an
explanation
for
that.
D
D
So
he
said,
however,
I
believe
these
are
merely
stylistic
changes,
accounting
or
the
differences
between
the
administration
of
the
government
medicaid
program
and
the
administration
of
a
private
policy
of
insurers.
C
A
Remember
if
you
could
send
that
response
into
the
committee
manager,
so
she
can
share
it
with
the
committee
members.
That
would
be
great.
Okay,
no
assembly.
A
B
Thank
you
so
much.
Madam
chair,
I
just
have
a
quick
question
and
my
ability
seems
to
be
my
word
of
the
day,
but
in
section
19,
where
the,
where
the
pharmacist
can
make
the
decision
to
extend
the
prescription
beyond
what
the
physician
or
practitioner
has
said,
could
this
open
up
a
pharmacist
to
any
kind
of
new
liability
if
something
went
wrong
with
extending
that
prescription
longer
than
the
doctor
had
which
cracked.
J
Dave
wheeze
for
the
record,
I
think
that's
an
excellent
question
and
I'm
not
an
attorney.
So
we
might
need
to
ask
them
that
question
and
there
might
be
a
provision
in
there
that
you
would
want
to
protect
the
pharmacist.
So
if
that's
your
intent,
but
it
would
be
clear
to
put
a
provision
that
if
the
pharmacist
acts
in
good
faith
that
they
can't
be
held
accountable,
good.
A
Thank
you,
mr
whis,
and
then
assemblymember
hardy.
If
you
would
get
clarification
on
that
and
then
you
can
share
it
with
the
committee
manager,
so
she
can
share
it
with
the
members.
I
also
have
a
question
from
assembly
member
o'neill.
H
H
J
I
just
I
just
wanted
to
be
clear
for
the
record
dave
we,
so
we
currently-
and
it's
listed
at
the
board
website-
that
we
have
a
waiver
through
regulation,
not
statute,
of
course,
where
during
the
emergency,
that,
if
there's
a
patient
that
needs
to
get
a
prescription
refilled
and
they
can't
cut,
they
attempt
to
contact
the
practitioner
and
they
cannot
contact
the
practitioner.
J
This
was
more
likely
at
the
beginning
of
the
pandemic,
of
course,
that
the
pharmacist
could
fill
that
prescription
for
30
days
couldn't
be
a
controlled
substance
and
that
they
had
to
notify
the
practitioner.
This
language
is
very
similar
to
the
waiver
guidance
that
we've
put,
and
so
yes,
this
would
be
in
an
emergency
and
it
for
my
time
with
the
board.
It's
it's
I've
seen
it
with
some
hurricanes
where
people
have
come
from
other
places.
J
We
saw
with
the
fires
over
in
california
when
the
people
came
over
from
the
fires
and
the
pharmacy
had
burnt
down.
Pharmacists
were
able
to
look
at
stores
that
were
close
to
them
and
look
at
the
record
walgreens,
the
walgreens
or
whoever
it
was,
and
so
yes,
they
would
be
able
to
fill
the
prescription
for
the
35
30
30
days,
but
they
have
to
notify
the
practitioner.
J
As
stated
in
subsection
two
of
section
b
and
again,
I
don't
have
a
sense
for
how
many
times
this
has
happened
during
the
current
pandemic,
but
I
have
not
received
a
complaint
that
somebody's
been
harmed
by
the
current
guidance
and
now
anytime.
It's
in
statute.
That's
the
best
way
in
my
mind
that
you
guys
are
saying
this
is
what
you
want,
as
opposed
to
me
doing
some
waiver.
H
And
I
appreciate
that
very
detailed
response,
because,
let
me
just
say
if
you
just
start
with
section
1
h2
go
to
line
11
section
3
go
to
line
19,
it
goes
on
and
on
again
do
we
need
to
adjust
or
clarify.
It
reads
on
all
numerous
pages
where
it
says
has
not
exceeded
the
number
of
refills
authorized
by
the
prescribing
practitioner.
J
That's
a
dave
wheats
for
the
record.
My
interpretation
is
that
it's
a
different
system,
that's
talking
about
insurance
coverage
and
that
they
want
to
make
sure
that
if
the
patient
has
a
refill
that
it's
covered
by
the
insurance
when
you
get
to
section
19,
that's
a
separate
component.
That's
talking
about
when
there
is
no
refill
and
the
pharmacist
can
use
a
professional
judgment
to
give
the
patient
some
in
an
emergency.
A
Thank
you
assembly,
member
o'neal,
and
I
do
have
one
last
question
too
assemblymember
hardy
or
mr
wiest.
If
you
know
this
might
be
a
question
that
you
can
answer,
do
you
know
what
happens
in
an
instance
where
a
pharmacist
issues
a
prescription
and
then
within
48
hours,
notifies
the
doctor
and
the
doctor
says:
no,
that's
not
a
valid
prescription.
They
should
not
have
got
one
who's
responsible
now
from,
I
guess,
collecting
that
prescription
back
or
making
sure
it's
staying
out
of
the
hands
of
the
patient.
J
I
I
don't
know
for
this
dave
wheats
for
the
records,
an
excellent
question
for
this
particular
scenario.
We,
the
board
of
pharmacy,
would
hold
the
pharmacist
responsible
for
contacting
the
patient
and
and
and
and
communicating
to
them
that
they
shouldn't
have
the
prescription.
J
This
comes
up
already
with
you
know
the
doctors
prescribe
something
and
it's
and
it's
filled
wrong
or
the
patient
or
they
wrote
the
wrong
med.
So
there's
a
process
where
practitioners
work
together.
That
happens
when
the
doctor,
you
know,
selects
the
wrong
patient
and
then
they
have
to
contact
them.
So
I
think
they
work
together.
J
You
could
always
put
more
clarity
in
there
that
it's,
the
responsibility
of
the
pharmacist
to
you
know,
terminate
that
prescription.
If,
if
the
doctor
says
no,
that
could
be
clarity
that
you
add
to
the
language,
but
I
would
I
would
hold
the
pharmacist
responsible
because
they
made
the
professional
decision
to
dispense.
A
A
N
Madam
chair,
it's
liz
mcmahon
with
the
retail.
Thank
you
please,
when
you're
ready.
Thank
you
very
much,
madam
chair
and
members
of
the
committee
and
thanking
the
sponsor
for
bringing
this
bill
forward.
This
simply
codifies
in
statute.
What
is
being
done
during
the
current
pandemic?
N
It
has
worked
well,
we
haven't
had
any
complaints
and
our
members
have
not
had
any
complaints,
and
we
haven't
seen
any
issues
with
this
at
this
time,
and
it's
really
important
to
understand
that
when
the
emergency
first
happened,
we
were
right
up
against
that
with
with
people
who
were
panicked,
with
not
being
able
to
get
their
medications
that
for
their
to
help
in
their
medication
management
for
their
therapies,
and
so
it
was,
I
think,
the
board
of
pharmacy
and
the
governor
for
working
together
and
making
this
happen
for
those
patients
out
there
in
nevada
that
needed
it,
and
I
think
this
bill
is
a
good
bill
that
has
an
opportunity
to
protect
the
patients
in
in
our
state.
A
A
B
Care,
the
public
line
is
open
and
working.
However,
there
are
no
callers
at
this
time.
A
Thank
you.
I
do
not
have
anyone
signed
up
to
testify
in
opposition
on
video,
so
can
we
check
the
telephone
line
for
anybody
wishing
to
testify
in
opposition.
B
A
Thank
you,
and
I
do
have
someone
who
signed
up
to
testify
on
video
in
neutral
julia
peake,
with
the
division
of
public
and
behavioral
health.
Do
I
have
julia
peek,
hi,
chair.
E
Thank
you.
We
were
just
here
to
answer
questions.
My
medicaid
partners
are
here,
as
are
we
for
public
health,
but
no
specific
comments.
Unless
there's
questions
for
us.
A
B
D
Yes,
thank
you,
madam
chair,
and
thank
you
committee
for
hearing
this
bill
and
for
your
comments
and
questions,
and
I
will
definitely
follow
up
and
get
the
information
and
continue
to
work
on
this.
I
think
it's
important,
as
was
stated
once
a
situation
like
this
arises
and
that
we
have
been
in
for
the
last
year,
people
that
rely
on
medications.
D
You
know
it's
a
scary
thing.
It
can
be
quite
nerve-racking
and
cause
anxiety
to
think
I
need
this
medication
and
how
am
I
gonna
get
it,
and
so
I
think
it's
important
for
that,
and
it
is
you
know.
As
I
said
it's
for
a
limited
circumstance,
and
I
you
know
we
wanted
these
people,
especially
seniors,
and
those
that
have
you
know,
conditions
that
they
rely
on
this
medication,
that
they
can
have
them
the
comfort
of
knowing
that
there
is
a
way
in
state
law
that
they
can
get
the
medications
that
they
need.
A
A
I
would
like
to
remind
those
present
that
the
period
for
public
comment
is
an
opportunity
to
discuss
general
matters
that
fall
within
the
purview
of
the
commerce
and
labor
committee.
The
public
has
already
been
given
ample
time
to
support
or
oppose
legislation,
and
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
continue
a
bill
hearing.
A
Your
testimony
during
public
comment
may
be
limited
to
two
minutes.
Please
address
your
remarks
to
the
issues
that
fall
within
the
jurisdiction
of
this
committee.
If
you
direct
your
remarks
to
issues
over
which
this
committee
has
no
oversight,
I
will
kindly
ask
you
to
redirect
your
remarks
or
terminate
them
be
respectful
of
committee
members
and
other
witnesses.
Do
not
comment
on
testimony
provided
by
others
speakers
and
do
not
make
personal
attacks.
You
may
always
submit
written
remarks
for
inclusion
in
the
meeting
record
with
that
broadcasting.