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A
Good
afternoon
and
I'm
going
to
call
to
order
the
assembly
committee
on
health
and
human
services,
madam
secretary,
please
call
the
role.
C
F
H
A
Here
we
do
have
a
quorum.
I've
asked
miss
kamlafi
to
record
assemblywoman
summer's
armstrong
present
when
she
arrives.
They
know
that
she
is
currently
presenting
in
another
committee
right
now
and
with
that
I'd
welcome
our
audience
to
joining
us
on
this
virtual
meeting.
We
have
three
bill
hearings,
so
I'm
just
going
to
get
right
into
it,
so
we
can
get
them
going
and
get
them
heard.
I'm
gonna
now
open
the
hearing
on
assembly
bill
205,
which
makes
various
changes
concerning
the
acquisition,
possession
provision
or
administration
of
auto
injectable.
I
Thank
you
chairwind
and
committee,
and
thank
you
for
hearing
ab205
presenting
with
me
is
trey
delapp
from
group
six
partners.
Mr
d
lab
has
worked
in
behavioral
health
addiction
and
recovery
policy
for
years
and
specializes
in
advocating
in
the
spaces
where
they
converge.
So
I'm
going
to
turn
it
over
to
start
to
mr
d.
J
A
J
Thank
you,
madam
chair.
My
name
is
tradie
lapp,
I'm
the
director
of
group,
six
partners,
and
I'm
here
today
on
behalf
of
everybody,
but
on
behalf
of
myself
regarding
ab205
and
I've
been
working
with
assemblywoman
cohen
on
this
bill.
My
role
is
to
sort
of
update
on
the
state
of
affairs
with
regard
to
some
statistics
that
are
relevant
to
this
population
and
I'm
going
to
make
some
references
to
document
that
that
was
sent
to
you.
But
I
wanted
to
talk
about.
J
What's
happened
in
2020
2020
was
a
a
the
largest
year
of
overdose
deaths.
Nevada
has
seen
so
far,
and
so
the
preliminary
data
for
2020
show
opioid
related
overdose
deaths
increased
by
27
percent
over
the
prior
year
to
the
highest
single
year
number
fatalities
since
2010
for
all
age
groups.
51
of
these
deaths
are
attributable
to
synthetic
opioids
like
fentanyl
fentanyl
is
50
times
more
potent
than
heroin
and
100
times
more
potent
than
morphine
preliminary
data.
2020
shows
the
number
of
unintentional
opioid
overdose.
J
Death
in
2020
was
twice
as
high
as
the
previous
peak
of
four
deaths
in
2015.
between
2010
and
2019.
The
average
annual
number
of
opioid
overdose
deaths
among
the
age
group
8-17
was
1.7
and
2.
In
2020
alone,
these
eight
deaths
represent
a
371
percent
increase
over
the
average
established
over
the
past
decade.
J
Seizures
of
these
illicitly
manufactured
drugs
have
increased
117
percent
according
to
nevada
haida.
The
combination
of
increased
supply
of
highly
potent
synthetic
opioids,
indistinguishably
and
deliberately
manufactured
to
appear,
like
other
medications
and
a
higher
rate
of
use,
accounts
for
an
increased
risk
of
opioid
death.
That
risk
has
shown
to
be
realized,
as
the
data
show
when
we
break
it
down
from
2010
to
2020..
J
The
dramatic
rise
in
overdose
death
among
eight
to
17
year
olds
has
lowered
the
median
age
of
unintentional
overdose,
opioid
overdose
death
from
49
years.
To
29
years
in
a
single
year,
harm
reduction
as
a
strategy.
Substantial
federal
dollars
have
been
granted
to
states
to
promote
harm
reduction
strategies,
inclusive
of
the
wide
distribution
of
naloxone
to
lay
persons
state
targeted
response
grants
have
been
distributed
to
states
to
expand
access
to
naloxone
nevada
has
distributed
over
16
000
doses
of
naloxone
since
february
2018.
J
hope
for
young
people
in
recovery
for
young
people
with
addictive
disorders.
There
is
hope
at
mission
high
school
in
las
vegas.
This
comprehensive
school
is
the
first
public
high
school
for
young
people
seeking
recovery
in
the
united
states.
Fifty
percent
of
the
students
there
are
credit
deficient,
100
percent
have
used
alcohol
or
drugs.
38
percent
have
had
involvement
with
the
justice
system
and
at
mission
high
school
students
are
surrounded
by
peer
community
and
supportive
adults,
giving
them
their
best
chance
of
recovery
from
addiction
occurring
so
early
in
their
lives.
J
This
bill
would
expand
access
to
naloxone
to
more
people,
therefore
increasing
the
opportunity
that
a
overdose
may
be
reversed.
The
key
here
is
that
the
synthetic
opioids
are
so
potent
that
the
risk
is
so
much
greater
and
that's
why
this
bill
is
very
important
and
I
will
stop
there
and
thank
you,
madam
chair.
I
I
It
will
not
cause
harm
so
to
be
clear
if
someone's
overdosing
from
and
from
opioids
they'll
die
without
intervention,
but
often
lives
are
lost
while
waiting
for
the
ambulance
to
arrive
and
naloxone
administered,
while
waiting
for
the
ambulance
saves
lives
and,
at
the
same
time
in
loxton
is
safe
and
more
benign
than
epinephrine.
I
In
fact,
it's
administered
to,
if
it's
administered
to
someone
who
is
not
overdosing,
it
just
doesn't
harm
them.
I
So
yesterday
I
distributed
to
the
committee
members
a
typical
naloxone
kit,
from
partnership,
carson
city
with
money
from
the
federal
government,
the
nevada
state,
opioid
response
reports.
They
have
distributed
13
185
kits
and
there
have
been
932
reversals
from
the
use
of
naloxone,
so
reversal,
being
someone's
someone's,
od
and
and
they're,
given
the
naloxone
and
it
it
basically
saves
them.
I
So
that's
932
nevadans,
who
would
have
died
if
they
had
not
received
naloxone
and,
as
I
hope
you
saw
in
the
the
kids,
because
I
hope
you
took
a
look
at
them.
There's
gloves,
there's
some
information
on
opioids
instructions
and
a
couple
of
naloxone
sprays
and,
as
you
can
tell
from
the
kit,
you
don't
have
to
have
training
to
save
someone's
life.
I
The
training
also
stresses
calling
for
medical
help,
and-
and
I
just
want
to
make
sure
we're
clear
that,
even
though
I'm
mentioning
a
carson
city
organization,
every
county
has
an
organization
that
will
provide
free
to
the
public,
these
kits
and
training
upon
request.
I
So
so
what
we
have
here
is
there's
a
problem
in
that
the
rate
of
of
our
students
who
are
overdosing
on
opioids,
using
opioids
and
overdosing
is
rising,
there's
a
way
to
solve
it,
which
is
using
the
naloxone
or
the
opioid
antagonist,
and
that
way
to
solve
it
doesn't
cause
cause
harm.
If
you
accidentally
give
the
naloxone
to
someone
who
isn't
overdosing,
it
doesn't
harm
them,
so
there's
something
we
can
do
about
it.
I
We
can
prevent
the
skyrocketing,
the
you
know:
eight
unintentional
overdoses
that
we've
seen
that's
a
300
percent
rise
in
numbers,
so
we
definitely
want
to
address
this
issue,
and
so
we
so
with
this
bill.
It's
a
way
to
address
this
issue.
So
let
me
go
through
the
bill
with
you.
I
So
if
we
start
with
section
one
that
allows
a
healthcare
professional
authorized
to
prescribe
an
opioid
antagonist
to
issue
to
a
public
or
private
school
in
order
for
opioid
antagonists,
for
treatment
of
opioid,
related
drug
overdose
and
provide
information,
it
also,
that
section
also
provides
information
that
that's
required
in
the
order
to
the
professional
who's
prescribed,
providing
the
antagonist.
I
The
section
also
includes
that
the
healthcare
professional
is
not
liable
for
an
error
or
a
mission
related
to
that
order,
which
is
not
gross
negligence
or
reckless
willful,
or
wanting
conduct
section,
2
authorizes
a
school
nurse
or
other
designated
employee
of
a
public
or
private
school
who
has
received
training
in
the
storage
and
administration
of
opioid
antagonists
to
administer
it
to
anyone
on
the
premises
of
the
school
who
is
reasonably
believed
to
be
experiencing
an
opioid
related
drug
overdose,
and
so,
as
you
can
see
in
that
section,
it's
just
adding
the
opiate
antagonist
language
to
the
auto
injectable
epinephrine
language
for
having
those
in
schools.
I
Section
three
is
conforming
language
in
the
maintenance
and
administration
of
autoinjectable
epinephrine
statute
or
statutes.
I
So
I
could
say
epinephrine
can't,
say
patrick
bull
now
I
can't
say
either
anyway.
Moving
on
sections
five
through
eight
of
the
bill
require
training
in
the
storage
and
administration
of
opioid
antagonists
for
the
designated
employees
of
the
public
or
private
school
that
obtain
that
obtains
an
order
for
opioid
antagonists.
I
Again,
schools
don't
have
to
do
this,
but
if
they
do
this,
there's
just
some
guidelines
that
they
have
to
follow,
which
sections
5,
sub,
2
and
8
sub
2
are
clear
that
the
schools
may
obtain
the
opioid
antagonists.
This
isn't
isn't
a
requirement.
It's
a
may.
I
Not
a
must
sections
5
and
8
additionally
exempt
a
school
school
district,
employee
of
a
school
and
certain
other
persons
affiliated
with
the
school,
from
liability
for
certain
damages
related
to
the
acquisition,
possession
provision
or
administration
of
auto
injectable
epinedrin
or
an
open,
opioid
antagonist,
not
amounting
to
gross
negligence
or
reckless
willful
or
wanton
conduct.
I
I'm
working
with
a
stakeholder
on
this
you'll
probably
hear
from
them.
We
want
to
just
clarify
what
these
protections
are
and
that
the
protections
apply
only
in
an
emergency
situation,
so
we
are
still
working
on
that,
but
we're
very
close
we're
at
the
we're
we're
in
agreement.
It's
just
getting
the
language
section.
I
A
E
Thank
you
and
thank
you,
71
cohen,
for
bringing
back
my
bill.
This
was
a
bill
that
I
presented
in
in
2019
and
I
actually
have
to
give
full
credit
to
assemblyman
hambrick,
who
initially
presented
the
bill
and
trey
you
and
I
worked
hard
on
this
bill
and
we
got
it
all
crossed
through
the
finish
line
through
both
houses,
and
then
it
sat
on
a
desk
and
died.
So
I
am
glad
that
you
have
bought
this
back.
So
I
appreciate
that,
but
I
definitely
wanted
to
give
credit
to
sen
assemblyman
hamrick.
E
This
is
one
of
his
priority
legislation
that
we
couldn't
get
quite
past
the
finish
line,
and
so
I
appreciate
you
bringing
it
forward
this
session.
As
trey
pointed
out,
the
pandemic
has
again
shown
us
the
we
were
getting
ahead
of
the
opioid
epidemic
and
the
overdose
deaths
until
this
pandemic
showed
us
where
we
were
really
lacking
in
it,
and
this
surge
is
real,
and
so
hopefully
the
members
of
this
committee
will
support
this
and
it
was
pretty
well
vetted.
I
do
have
a
question,
however.
E
I
pulled
up
the
old
bill
and
it's
very
similar.
One
of
the
previous
concerns
that
were
brought
up
through
multiple
testimonies
trey
was
the
availability
of
narcan
as
an
er.
I've
worked
the
ers
I've
given
way
too
many
doses
that
I
would
have
liked
to
do
of
narcan,
and
there
was
some
concern
about
its
availability.
I
see
now
that
this
nasal
spray
so
as
assembling
column
brought
up.
This
is
not.
This
is
a
nasal
spray.
E
So,
unlike
the
epi,
where
there
is
a
syringe
involved,
the
auto
inject,
this
is
really
a
nasal
spray,
so
really,
as
she
pointed
out,
zero
risk.
So
that
was
one
of
the
other
concerns
in
previous
testimony.
Is
you
know?
How
do
you
know
for
sure
if
you
use
it
well,
we
already
testified
that
there
was
really
no
harm
to
give
it.
You
have
an
unconscious
person.
E
You
can
give
them
glucose
in
case
of
diabetic
or
you
give
them
narcan
and
see
if
they
wake
up
or
not,
but
there
was
always
worried
about
the
shot
and
the
availability
so
has
the
supply
increase.
Now
that
we
could
adequately
supply
everybody
with
narcan.
That's
my
first
question,
then
I
have
a
follow-up.
If
I
might
manage
it.
I
I'm
sure,
if,
if
I
can
just
address
something
leslie
cohen
assembly,
district
29
before
mr
d
lap
answers
that
I
kind
of
want
to
be
clear
about
the
history
of
what
happened
last
session,
and
certainly
this
is
this.
This
is
assemblyman
hambrick's
bill
and
I
promised
him
I
would
bring
it
back.
It
didn't
sit
on
a
desk
and
die
it
there
was.
It
basically
was,
was
really
getting
watered
down
to
the
point
of
where
it
just
didn't
seem
like
it
would
have
any
effectiveness.
I
So
that's
why
I
said
to
him:
if
you
you
know,
if,
if
you
agree
I'll
I'll
bring
it
back
because
we
wanted
it
to
be
effective
and
have
some
something
to
it,
so
that's
basically
where
it
is
and
and
why
I
brought
it
back,
but
with
that
I'll
I'll
turn
it
over
to
mr
d
lat
too.
If
he
wants
to
answer
that
question.
J
Thank
you,
madam
chair.
I
I
I
think
your
question
specifically
was
about
the
available
supply
of
of
the
nasal
delive
of
naloxone.
That's
something
I
would
have
to
check,
but
this
this
preparation
of
it.
As
you
noted
this,
there's
no
needles.
This
is
the
nasal
administration
spray.
This
is
what's
given
to
the
lay
public.
I
would
envision
that
this
is
the
most
appropriate
formulation.
J
Well,
the
formulation,
it's
the
delivery
system,
that's
the
key
detail,
but
this
nasal
spray
does
eliminate
the
needle
fear
and
the
worry
of
of
that
then
there's
a
number
of
other
things
there.
As
far
as
the
overall,
why
naloxone's
been
around
and
proved
safe
since
1971
and
again
thousands
of
doses
have
have
been
distributed
to
the
public?
So
if,
if
the
question
was,
would
we
have
enough
to
put
some
in
every
single
school?
I
am
supremely
confident
we
could.
E
Pull
up
question
on
that,
madam
chair,
has
there
been?
Thank
you.
Thank
you
when
we
heard
this
in
the
past.
It
was
a
lot
of
volunteers
and
some
funds,
because
this
is
comes
with
a
cost,
and
so
the
funding
for
this
lots
of
grants
for
the
schools
is
that
funding.
Have
you
seen
it
still
available
either
someone
cohen
so
that
agencies,
schools
who
wanted
to
get
this
perhaps
could
have
some
assistance
and
then
is
there
any
agreement
on
the
shelf
life
and
turning
in
unused
packets?
I
So
leslie
cohen
assembly,
district
29,
as
as
far
as
cost,
I
think,
there's
a
couple
of
things.
We
have
to
keep
in
mind
number
one.
This
is
a
policy
committee,
but
number
two.
This
again
the
language
is
is
is
not
obligatory
for
the
schools
it's
in
may
there
there
is.
There
are
some
federal
funds
as
far
as
I'm
aware,
but
I
think
that's
not
really
the
point
of
the
bill.
I
We
want
to
get
something
in
place
and
if
the
school
decides
they
want
to
do
this,
they'll
they'll
get
the
materials
they'll
get
the
sprays.
So
I
I
that's
where
I
think
we
need
to
focus,
and
then
mr
d
lab,
if
you
have
anything
to
add
to
that.
J
Madam
chair,
thank
you
to
assimilate
titus.
The
the
naloxone
that
is
distributed
to
the
community
is
paid
for
by
the
federal
government,
and
I
I
find
that
to
be
a
very
compelling
note.
For
two
reasons.
One
federal
grant
dollars
are
being
used
to
buy
a
medication
to
give
to
the
lay
public
for
the
administration
to
people
who
may
need
it
that
that's
a
key
detail.
J
So
when
all
of
the
doses
that
we've
mentioned
have
been
dispensed
to
the
community,
the
state
have
all
been
paid
for
by
a
variety
of
of
grant
sources
from
samsa
the
sub,
the
federal
substance
abuse
mental
health
services,
health
administration,
it's
big
big
acronym,
but
their
opioid
str
grant
state
targeted
response
grant
was
a
major
chunk
of
money
that
came
into
the
state
for
the
distribution
of
it.
There's
a
number
of
resources
that
have
dashboards
and
data,
and
things
like
that.
J
So
that
seems
in
an
interesting
scheme
of
things
covering
the
cost
of
the
product.
It
there's
probably
the
easiest
part
to
solve.
A
And
we
also
have
our
policy
analyst
on
that
might
be
able
to
clarify
that
this
is
not
an
unfunded
mandate
because
of
that
may
language
miss
kamalasi.
Would
you
be
able
to
come
on
and
kind
of
clarify
that
as
well.
C
Thank
you,
I'm
sure
megan
come
alongside
the
research
division
for
the
record,
it
is
enabling
language,
and
so
school
districts
or
schools
would
choose
to
participate
in
the
program.
I
think
what
was
said
before
is
accurate.
There
are
lots
of
sources
of
federal
funds
for
this
type
of
for
these
types
of
naloxone
kits
and
they're
being
distributed
widely,
and
so
it
may
even
work
for
a
school
or
school
district
to
work
with
local
non-profits
or
local
community
organizations
to
obtain
naloxone.
As.
K
Madam
chair,
my
question
was
regarding
the
fiscal
notes
that
were
attached
and
the
conversation
that
we're
just
having
with
the
feds
are
paying.
For.
I
know
this
is
enabling
language.
However,
I'm
still
confused
if
we're
putting
enabling
language
in
so
the
schools
can
obtain
the
federally
paid
antagonist.
I
Leslie
cohen
assembly
district
29
well
to
be
clear.
The
the
fiscal
note
that's
that's
up
is:
is
zero,
has
zeros
across
the
board
and
we're
allowing
the
schools
to
obtain
the
the
naloxone
to
have
it
in
the
school
to
use
it
if
they
choose
to
have
someone
at
the
school
trained
to
use
it,
which
again
is
a
very
short
training
session
and
not
extremely
technical?
I
And
if
the
schools
choose
it's
not
that
we're
saying
they
can
go,
get
the
money
from
the
feds
we're
saying
they
can
do
this
and
we're
saying
that
the
feds
have
been
distributing
and
providing
funds
for
the
kids.
But
it's
they're,
not
it's
not
they're,
not
correlated.
K
K
Clarification
my
question:
it
was
not
the
fiscal
note
for
the
state.
However,
it
was
one
of
the
local
governments.
The
clark
county
school
district
is
showing
roughly
182
000
over
the
biennium,
and
a
number
of
the
other
school
districts
are
also
showing
fiscal
impacts
to
this,
and
I
understand
that
we're
trying
to
get
the
feds
and
I
do
think
this
is
a
good
program,
but
I
just
didn't
want
to
get
on
the
record
that
there
are
physical
notes
from
the
local
municipality.
I
And
leslie
cohen
assembly
district
29,
I'm
sorry,
I'm
not
seeing
those
I'm
only
privy
to
to
what's
on
on
nellis
for
the
public,
so
I'm
not
seeing
anything
from
the
school
district.
So
my
apologies,
however,
oh
and
there
they
are.
However,
I
would
just
remind
you
again:
it's
it
it's
it.
As
miss
khan,
lossy
said
it's
it's
enabling
language,
so
they
can
choose
to
do
this
or
not.
They
can
choose
to
do
it
and
pay
for
it.
I
They
can
choose
to
do
it
and
find
other
resources
to
pay
for
it,
but
but
they
will
choose
whether
or
not
to
do
it.
H
Thank
you,
chair
and,
and
just
to
clarify,
I'm
looking
at
the
fiscal
note,
and
it
looks
like
there
is
some
confusion
from
the
school
districts
as
to
accessibility
of
these
resources
and
the
need
for
training.
So
I
would
encourage
that.
Maybe
there
be
a
letter
sent
to
them
just
letting
them
know
where
they
can
find
this,
and
my
question
has
to
kind
of
do
with
the
accessibility
piece
you
know
and
thinking
about
17
year
olds,
that
I
know
16
and
17
year
olds.
H
Some
of
them
are
incredibly
capable
people
and
with
kind
of
the
prevalence
of
the
of
the
supply.
What
is
there
anything
that
inhibits
a
student
from
administering
something
like
this
after
school
and
then
my
other
question
is
if
it
is
available
to
the
public?
I
I
There
was
just
earlier.
In
march,
there
was
a
grant
announced
by
the
federal
government,
it's
on
the
samhsa
page,
with
information
about
how
to
get
a
grant
for
the
kits.
Then,
as
to
your
question,
I'm
sorry
would
you
do?
Would
you
state
those
again.
H
Oh,
it's
about
a
bit
availability,
so
students
potentially
having
this-
you
know
in
a
backpack
because
they
are
careful
and
thoughtful
people
can
they
administer
that
on
school
property
and
then
the
importance
of
having
it
spelled
out
in
here
the
enabling
language
for
the
healthcare
professional
to
prescribe
this
at
the
school.
I
The
purpose
of
that
leslie
cohen
assembly,
district
29.
As
far
as
a
student
I
mean
I
from
what
I've
learned
about
this.
They
probably
could
do
it,
but
this
bill
doesn't
allow
for
it
that
would
have
to
be
done
by
a
different
vehicle.
The
bill
is
for
someone
in
the
school
to
be
trained
an
employee
of
the
school
to
be
trained
to
do
it.
I
As
far
as
the
you
know,
I
don't
know.
Maybe
we
can
ask
legal
about
mr
krentz
about
why
the
language
is
in
is
in
there
it's
it's
the
it's.
The
bill
very
much
follows
the
epinephrine
language,
and
that
was
existing
epinephrine
language
about
the
prescriber.
I
C
L
H
Okay,
thank
you.
That
makes
sense.
I
was
just
curious
about
the
availability
of
of
narcam.
I
have
a
box
of
it
at
my
house
that
I
was
intending
to
take
to
an
event
this
summer,
so
I
know
it's
available
out
there
I
just
wanted.
I
wanted
some
clarification
on
the
enabling
and
then
also
I
you
know.
I
I
think
it's
important
to
understand
whether
students
can
do
an
admit
like
administer
this
if
they
have
it
available
on
school
grounds
or
whether
there's
liability
associated
with
that.
H
A
Thank
you,
and
with
that
we
will
go
next
to
our
next
question
from
assemblywoman
gorlo.
C
Thank
you,
chairwin,
and
my
question
actually
was
already
answered.
However,
you
know
talking
through
this:
could
you
could
somebody
walk
me
through
on
what
would
it
look
like
if
somebody
was
overdosing
just
so
that
you
know
what,
if
I'm
at
the
grocery
store,
mall
or
in
a
park,
and
someone
falls
over,
I'm
not
so
sure
that
this
would
have
been
my
first
thought
to
grab
a
narcan
and
administer
it.
So
what
might
some
of
the
symptoms
be?
For
someone
who
is
overdosing.
I
Leslie
cohen
assembly
district
29,
and
that
is
part
of
the
required
training.
However,
mr
tilap,
do
you
want
to
tell
the
you
would
told
me
a
story
about
a
situation
where
someone
was
oding
and
it
took
a
while
to
figure
that
out
and
get
the
narcan
provided
for
that
person?
J
Thank
you
for
the
question
assembling
one
gorlo
that
this
would
look
like
a
variety
of
things,
so
the
training
would
basically
say
if
you
encounter
someone
who's
unresponsive,
not
not
conscious,
they
may
be
in
and
out
they
may
not
be
able
to
talk
they're
difficult
to
rouse
the
the
protocol
would
be
to
call
9-1-1
or
activate
ems
or
whatever,
and
then,
if
you
have
the
nasal
minister
narcan,
you
would
open
it
and
then
the
instructions
on
how
to
use
it
are
in
there
the
story
that
and
then
you
would
administer
it.
J
One
caveat
in
this
came
up
by
the
last
session
as
well
is
that
it
narcan
is
very
effective
only
if
someone
has
opioids
on
board
period.
So
it's
like
it's
been
described
as
a
lazarus
drug.
It
does
one
thing
it
knocks
it
blocks:
it
blocks
the
effect
of
the
opioid,
so
the
person
will
immediately
reverse
I've.
There
are
a
number
of
of
cases
and
one
one
case
that
got
some
media
was
a
highway.
J
Trooper
was
in
the
middle
of
nowhere
and
a
person
who
was
riding
a
bus
was
overdosing
and
unresponsive
and
the
bus
driver
pulled
over
and
the
first
responder
was
a
highway
trooper
in
the
middle
of
nowhere.
He
had
just
gotten
his
training
on
narcan,
so
his
body
cam
footage
actually
shows
the
entire
encounter
where
he
was
attempting
to
talk
to
the
person.
The
person
was
unresponsive
and
was
unable
to
do.
They
were
doing
this
journal,
rob
he
was
unable
to
to
rouse
and
he
actually
kind
of
took
him
off
the
bus.
J
And
then
there
was
some
assistance.
They
were
actually
doing
some
cpr
and
rescue
breathing.
Then
he
remembered
his
narcan
and
then
he
administered
it
and
in
the
meantime
he
had
called
for
a
medevac
helicopter.
So
a
helicopter
was
coming.
Then
he
remembered
the
narcan
and
he
administered
it
and
the
and
the
the
patient
woke
up.
J
So
this
is
critically
important,
especially
to
communities
where
that
they're,
not
five
minutes
away
where
in
las
vegas,
you
might
call
an
ambulance
and
two
ambulances
are
going
to
show
up
within
five
minutes,
but
in
other
parts
of
the
world.
That
may
not
happen
the
the
the
major
piece
of
legislation
that
had
passed
in
2015,
the
good
samaritan,
drug
overdose
act,
which
created
four
nrs453c.
J
Its
intent
was
to
protect
individuals
who
would
administer
this
to
others,
because
the
the
thing
in
the
balance
is
the
life
of
the
person
and
and
the
intent
of
that
bill
is
to
relieve
any
hesitancy
in
that,
but
again,
the
and
and
and
someone
titus
mentioned
it
sometimes
in
the
clinical
setting.
This
is
used
as
a
assessment
tool
that
if
they
administer
the
narcan
and
there's
no
change
in
the
patient's
condition
that
it
it
something
else,
but
if
it
does
change
their
condition
it.
It
shows
that
that
opioids
are
on
board.
J
J
J
J
And
what
can
happen
is,
if
there's
a
number
of
reports
in
a
specific
area,
then
that
triggers
an
alert
and
now
you
know
that
there's
a
batch
of
this
synthetic
fentanyl
lace,
stuff
in
a
particular
area
and
overdoses,
are
going
to
start
happening
so
from
a
surveillance
perspective,
that's
critical
information,
so
the
administration
of
narcan
is
an
indicator
that
opioid
overdoses
are
occurring
and
that
indicator
then
prompts
a
stronger
public
response
and
I
apologize.
That
was
a
lot
more
than
you
asked,
which
was
what
is
it?
A
At
this
time,
I'm
going
to
do
one
last
call
to
see
if
we
have
any
questions
before
I
go
to
testimony
and
support
opposition
in
neutral
of
assembly
bill
205,
seeing
none
broadcast
services
can
we
please
go
to
the
callers
to
the
line
about
callers
in
support
of
assembly
bill
205.
I
would
remind
callers
to
please
clearly
state
and
spell
your
name
for
the
record
and
limit
your
comments
to
two
minutes
with
that
we
can
begin.
G
F
Hi,
this
is
joseph
heck
heck
representing
red
rock
government
relations
on
behalf
of
the
nevada
osteopathic
medical
association.
Thank
you
chairwin
and
members
of
the
committee
on
behalf
of
the
nevada,
osteopathic
medical
association.
I
voice
our
strong
support
for
ab205.
We
have
provided
a
more
complete
statement
for
the
record
that
is
available
on
nellis.
F
While
all
attention
has
been
fixated
on
the
coveted
pandemic,
we
cannot
lose
sight
of
other
public
health
crises
to
include
the
opioid
epidemic
that
is
plaguing
our
nation
and
state
and
in
some
ways
the
isolation
and
depression
associated
with
coveted
mitigation
measures.
That
is
why
we
applaud
assemblywoman
cohen's
efforts
to
make
naloxone
trade
name
narcan
readily
accessible
in
schools
across
nevada.
F
This
safe
antidote
has
proved
effective
in
saving
lives
when
administered
by
laypersons
and
taking
the
same
approach
as
the
legislature
used
when
making
epinephrine
auto
injectors
available
in
schools
is
a
logical
and
much
needed
next
step
in
combating
opioid
overdoses.
We
urge
it
swift
passage.
Thank
you.
G
N
Good
afternoon,
chair
nguyen
and
members
of
the
committee,
this
is
kendra
burgie,
k-e-n-d-r-a
b-e-r-t-s-c-h-y
and
I'm
with
the
washoe
county
public
defender's
office
on
behalf
of
my
office,
as
well
as
the
clarks
county
public
defender's
office.
We
want
to
thank
assemblywoman
cohen,
as
well
as
mr
d
lap
for
bringing
for
this
important
bill.
We
do
hope
and
believe
that
this
will
save
lives,
especially
the
lives
of
our
children.
So
we
appreciate
this
effort.
Thank
you.
So
much.
G
C
Jamie
ross
for
the
record
j-a-m-I-e-r-o-s-s
good
afternoon
sharon
committee
members,
I
work
in
substance,
misuse
prevention.
We
do
have
free,
narcan
and
or
naloxone
trainings
at
our
agency,
with
the
increase
of
illicitly
manufactured
fentanyl
in
our
drug
supply
in
nevada.
Our
concern
is
the
increase
in
fatal
overdoses
of
children
under
18
that
occurred
in
2020.
C
Most
of
the
fentanyl
seed
in
nevada
is
in
fake,
pressed
pills
that
cannot
be
differentiated
from
pharmacy
manufactured
pills.
Youth
who
may
not
use
heroin
but
perceive
a
pill
of
oxycodone
to
be
safer
than
heroin
would
not
be
able
to
tell
that
this
pill
has
fentanyl
in
it.
The
goal
is
to
decrease
overdoses
and
increase
access
to
naloxone
is
a
safe
and
effective
way
to
do
that.
There
is
also
currently
a
grant
open
through
samsa's,
first
responders,
comprehensive
addiction
and
recovery
act,
grants
for
funding
for
additional
naloxone.
Thank
you.
G
N
N
N
Lastly,
we've
not
had
a
documented
opioid
overdose
case
on
school
campus
in
the
recent
past.
I
know
this
is
a
policy
committee,
but
at
least
last
session
the
bill
did
not
go
to
ways
and
means.
I
would
hope
that
this
session
we
may
get
an
opportunity
to
discuss
potential
physical
impacts
in
ways
and
means,
if
necessary.
Thank
you,
madam
chair.
G
F
Madam
chair
members
of
the
committee
brad
keating
b-r-a-d
keating
k-e-a-t-I-n-g,
calling
on
behalf
of
the
clark
county
school
districts,
calling
in
a
neutral
capacity
on
this
bill,
since
this
is
a
policy
committee
just
wanted
to
pass
along
a
few
important
facts
for
the
committee
to
know.
Ab-205
is
proposing
to
have
schools,
acquire,
maintain,
proper
and
secure,
maintains
storage
and
provide
training
to
licensed
and
unlicensed
employees
to
recognize
the
signs
and
symptoms
of
opioid
overdose
and
then
to
accurately
administer
an
opioid
anti-antagonist.
F
While
monitoring
the
student's
response.
Unlicensed
assistive
personnel
at
schools
are
often
reluctant
to
be
trained
in
administering
injections,
particularly
during
a
medical
emergency
when
there
are
varying
circumstances
to
consider
and
careful
ongoing
monitoring
of
the
student
needs
to
take
place.
F
Also,
the
current
basic
life
support
guidelines
recommend
an
automated
external
defibrillator
aed
to
be
available
when,
when
administering
an
opioid
antagonist,
aeds
are
only
in
high
schools
and
administrative
buildings
in
the
clark
county
school
district
and
therefore
they
would
only
be
they
would
be
the
only
sites
equipped
to
manage
an
opioid
overdose
administration
of
those
opioid
antagonists
would
not
be
safe
to
administer
in
elementary
and
middle
schools.
Without
the
proper
emergency
equipment
available,
including
aeds,
so
again
is
this:
a
policy
decision
by
the
legislature.
G
M
Ccea
is
testifying
in
neutral
on
av205.
We
appreciate
the
intent
of
the
bill,
but
we
do
have
questions
on
the
policies
for
administration
notice
that
may
potentially
be
given
to
parents,
and
we
are
slightly
concerned
about
the
implementation
date
being
so
soon
with
our
current
retention
issues
for
teachers
and
licensed
professionals.
This
isn't
to
say
that
we
are
not
supportive
of
the
intent
of
the
bill.
It
is
completely
necessary
and
we
do
believe
that
it
will
positively
impact
our
students,
especially
our
students,
struggling
with
opioid
addictions.
M
We
just
ask
that
the
members
that
are
on
this
committee
that
are
also
on
the
committee
on
boys
means
consider
payment
from
the
opioid
for
the
opioid
antagonists
from
the
aeg's
opioid
settlement
funds,
or
a
request
that
the
office
of
grant
procurement
equivalent
pay
special
attention
to
those
samsa
funds.
We
look
forward
to
working
with
the
sponsor
to
ensure
implementation
of
this
bill
is
impactful,
prevent
and
prevent
all
unnecessary
deaths
caused
by
opioid
overdoses
and
we're
also
looking
forward
to
ensuring
that
this
does
not
take
money
away
from
our
classrooms.
M
A
Thank
you,
and
I
will
remind
our
people,
testifying
in
support
opposition
and
neutral
that
this
is
a
policy
committee.
So
if
you
have
concerns
with
some
of
these
other
issues,
I
suggest
you
bring
them
up
with
the
bill
sponsor
or
in
our
money
committees,
and
with
that
do
we
have
any
other
colors
in
neutral.
I
Remarks,
thank
you
chair
at
leslie,
cohen
assembly,
district
29..
Let
me
mr
d
lap
do
you?
Would
you
like
to
make
any
closing
statements.
J
Thank
you
again,
madam
chair
and
assembly
woman
cohen,
and
for
the
opportunity
to
talk
about
this,
and
for
as
long
as
we've
had
awareness
that
opioid
overdose
is
a
public
health
issue.
We
have
been
working
on
a
number
of
fronts,
and
this
is
a
a
piece
of
a
much
wider
public
health
effort
that
involves
how
prescriptions
are
written.
How
how
much
the
prescription
monitoring
program
is
is
used
this
when
we
use
the
example
of
the
lay
person
administering
the
naloxone,
that's
the
expectation
and
it
it
it's.
J
The
intent
of
the
good
samaritan
drug
overdose
act
to
protect
people
to
encourage
that
kind
of
activity.
There
are
a
number
of
schools
and
the
national
association
for
school
nurses
offers
a
number
of
of
resources
in
designing
proper
school
policy.
J
J
J
One
thing
about
the
expiration
date,
for
example,
is
that
the
fda
has
extended
the
expiration
for
three
years,
so
now
they
are
good
for
three
years
instead
of
one,
and
that
was
a
change
so
where
it
might
be
deployed
in
a
school.
I
think
there's
a
number
of
resources
that
can
work
with
that,
because
there
are
school
districts
and
states
that
have
done
this
and
done
so
successfully.
J
The
policy
brief
that
was
done
by
nick
rip,
the
nevada
institute
for
child
research
and
policy
showed
that
a
survey
of
school
nurses
showed
that
only
5.2
percent
of
school
nurses
ever
administered
naloxone.
J
Well,
if
that
percent
did,
that
means
that's
one
less
lost
life
of
a
student
and
if
we
have
the
opportunity
to
do
that,
that's
very
valuable.
Also,
the
education
about
opioid
use
and
the
especially
the
extreme
prevalence
of
the
synthetic
opioids
is
very
compelling
to
some
sort
of
action.
So
this
is
a
dynamic
process.
There
are
a
lot
of
community
partners
involved
in
this.
We've
done
a
lot
of
work.
The
legislature's
done
a
lot
of
work,
there's
a
lot
of
resources
and
and
stitching
that
together
is
something
that
we
can
certainly
do.
J
I
would
be
willing
to
to
have
a
conversation
or
work
out
the
details
as
far
as
what
the
expectations
are
with
this
particular
intervention.
But
again
this
is
so
important
and
I
just
want
to
emphasize
the
final
detail
here
is
the
tremendous
spike
eight
in
clark
county
between
8
and
17
in
one
year
the
the
peak
was
four,
so
it's
a
huge
spike,
also
27
statewide,
of
of
overdoses,
unintentional
of
the
synthetic
opioids.
J
J
We
don't
have
a
lot
of
time
when
we
see
such
a
profound
impact
in
a
single
year
again.
Thank
you
for
considering
this
legislation.
A
And
you
know
prior
to
going
to
assemblywoman
cohen,
I'm
so
sorry,
I
just
didn't
see
it
assemblywoman
venus
thompson.
I
think
she
had
a
question.
I
don't
know
if
the
people
can
answer
it,
but
I
will
turn
it
over
to
her
to
see
whether
or
not
we
can
and
if
we
can
get.
O
O
Yeah
and
typically
in
a
normal
hearing,
we're
able
to
ask
questions
of
people
who
testify.
I
know
it's
been
a
little
bit
different
this
session
and
we
really
haven't
been
in
the
practice
of
asking
questions
of
of
people
who
are
testifying
via
the
phone.
But
it's
probably
that
point
of
the
session
where
we
we
can
do
so.
So
I
appreciate
that
chairwoman,
but
I
wanted
to
understand
a
little
bit
better.
Some
of
the
the
neutral
comments
by
the
school
districts
related
to
cost.
O
O
So
I
guess
I'm
not,
and
then
I
heard
requests
that
this
go
to
the
committee
on
ways
and
means
which
I
think
they
is
understood
to
not
be
practical,
because
we
only
send
things
to
ways
and
means
that
are
under
the
purview
of
the
state
budget.
And
this
isn't
obviously
their
budgets
are
their
budgets.
But
since
their
budgets
are
their
budgets,
I
guess
I
wanted
to
be
able
to
hone
in
on
the
bill
a
little
bit
more
where
they
thought
specific
costs
were
coming
from.
O
I
know
I'm
looking
at
washoe
counties
and
I
did
the
math
and
it
looked
like
at
150
and
then
the
amount
they
listed
there.
They
were
assuming
120
schools,
so
I
think
you
know
getting
the
the
naloxone
into
every
single
school,
but
I
don't
see
anything
in
the
language
that
says
that
I
and
then
on
clark
county's
one.
A
I
think
we
are
trying
to
see
if
we
can
get
them
back
on
the
line.
I
don't
know
if
we're
going
to
be
able
to
if
they
are
listening.
I
know
that
our
staff
is
trying
to,
but
I
believe
that
somebody,
like
cohen,
could
probably
answer
some
of
these
questions,
because
I
know
she
has
had
conversations
with
them.
O
I
think
it's
fine
for
the
school
districts
to
give
us
that
I
mean
it's
their
argument
to
make
not
the
bill
sponsors,
but
I
think
that
would
be
helpful
information
to
get
for
them
to
get
to
the
committee
is
if
they
could
just
cite
the
specific
section
that
gives
them.
You
know
that
is
that
is
causing
the
the
fiscal
for
those
that
have
specific
fiscals.
You
know
if
they
could
just
help
us
understand
the
thinking
behind
that
number.
O
That
would
be
helpful
for
me
and
then
that
way
we
don't
have
to
wait
for
them
to
come
back
on.
If
we
get
that
information
and
and
then
we're,
we
can
make
that
public,
it
would
be
helpful.
I
appreciate
that
chair.
I
Chair
so,
with
your
permission,
I'll
just
wrap
up
leslie
cohen
assembly
district
29-
I
I
will
say
the
mention
of
ways
and
means
was,
was
my
mistake
and
I
think
they
were
just
following
along
with
what
I
what
I
had
said.
However,
I
just
want
to
kind
of
address
a
few
things
that
were
said
and
that
I
have
found
to
be
an
issue
and
and
kind
of
confusing
from
the
parties
that
were
neutral.
So
we've
heard
that
okay,
well,
there
aren't
nurses
in
every
school
and
the
the.
I
The
sorry
that
that
the
aids
don't
have
any
medical
training.
Well
again,
you
don't
need
medical
training
to
do
this.
You
just
need
the
training
that
is
offered
for
free
and
is
available.
It's
available
online.
It's
so
that
shouldn't
be
an
issue
also
another
that
was
made
that
I
want
to
address.
Is
you
know
we
want
the
bill
to
say
that
you're
going
to
get
the
funds
from
the
the
attorney
general's
opioid
settlement
funds?
Well,
my
understanding
is
those
aren't
ours
to
to
play
with
so
they're.
I
You
know
they're
the
attorney
generals,
so
that's
that's
not
really
relevant.
On
top
of
that,
another
thing
that
I
want
to
address
and
and
just
stress
as
much
as
possible
is
this-
is
enabling
it's
enabling
language.
The
districts
don't
have
to
do
it
if
they
don't
want
to.
I
hope
that
if
we
pass
it,
they
will
see
their
way
clear
for
wanting
to
do
this
and
then
one
other
thing
is.
I
I
do
believe
my
understanding
is,
and
I'm
I'm
getting
kind
of
a
message
from
a
doctor
that
that
the
there
was
a
misrepresentation
by
the
clark
county
school
district
of
the
need
for
the
aed
with
narcan.
I
I
It's
it's.
My
understanding
is
it's
two
separate
treatments
and
two
different
problems,
and
if
a
person
is
unconscious
or
unresponsive
without
a
pulse
and
aed
is
the
first
intervention
that
should
be
re
that
should
be
applied,
but
they
don't
necessarily
have
to
be
done
together.
I
So
and
then
I
will
also
again
reiterate
with
what
mr
dilap
had
mentioned
about
how,
when,
when
medical
professionals
don't
know
what's
wrong
with
someone,
they
will
give
them
the
narcan
first,
because
again
it
doesn't
hurt
them.
So
if
they're
in
anaphylactic
shock-
and
you
give
the
narcan,
it
doesn't
hurt
them,
but
the
reverse,
if
they're
in
and
if
they're
oding
and
you
give
them
the
medication
for
the
anaphylactic
shock
that
could
harm
them.
So
that's
just
something
to
keep
in
mind.
I
I
will
certainly
keep
working
with
the
school
districts
and
and
try
to
get
them
to
a
place
where
they're
wanting
to
do
this.
I
will
also
provide
more
information
about
the
aed's
to
clarify
that
so
that
you're
not
listening
to
me,
who
is
not
a
doctor
and
with
that.
I
appreciate
your
attention
and
questions
and
thank
you
very
much
for
the
hearing.
A
Thank
you,
and
actually
we
have
lindsay
ander
anderson
back
on
the
line
broadcast
services.
If
we
can
go
to
her,
that
would
be
wonderful
and
the
last
digits,
I
think,
are
4-1-1.
G
Oh
sure
I
do
not
have
a
call
ending
4-1-1
right
now,
but
if
lindsay
anderson
can
press
star
nine
to
raise
her
hand
so
that
I
can
identify
which
call
she
is.
P
Thank
you
and
good
afternoon
chairwin
and
the
members
of
the
assembly,
health
and
human
services
committee
for
the
record.
I
am
assemblywoman
danielle
monroe
moreno,
representing
assembly
district
one
I'm
here
today
to
present
for
your
consideration
assembly
bill
287,
a
measure
providing
for
the
licensing
and
regulating
of
freestanding
birthing
centers
joining
me
here
today
and
presenting
this
bill
is
dr
tara
raines,
miss
april
clyde,
owner
of
serenity,
birth,
centers
in
las
vegas
and
miss
genevieve
burkett,
the
director
of
nursing
at
serenity,
birth
centers.
P
During
the
80th
legislative
session
I
presented,
and
this
body
passed
with
an
overwhelming
majority
ab169,
which
established
the
maternal
mortality
review
committee.
It
was
important
to
pass
that
legislation
because
maternal
mortality
was
and
still
is
rising
in
the
u.s
as
it
is
declining
in
other
countries.
P
P
P
P
O
C
P
Thank
you,
madam
chair
families,
in
my
community,
and
I'm
sure
in
yours
are
looking
for
healthy
options
and,
I
believe,
freestanding
birth.
Centers
are
one
of
those
options.
Ab287
simply
defines
a
nevada
statute.
What
a
freestanding
birthing
center
is,
and
with
your
permission,
I
return
the
remainder
of
this
presentation
over
to
my
co-presenters.
Thank
you.
Q
Thank
you.
Excuse
me,
thank
you.
This
is.
Tara
reigns
for
the
record.
With
your
permission,
I'd
like
to
share
my
screen
and
share
a
brief
presentation.
M
Q
So,
as
was
explained
in
that
video
that
was
previously
shared,
birth,
centers
can
be
considered
more
of
a
maxi
home
than
a
mini
hospital.
They
are
a
safe
place
for
birthing
people
and
their
families
to
have
babies,
receive
prenatal
care
and
then
receive
postpartum
support.
Q
The
proliferation
of
birth
centers
is
on
the
rise
currently
as
the
assembly
women
mentioned
previously,
particularly
in
the
wake
of
covet
19
we've
seen
an
increased
number
of
birth
centers.
Currently
there
are
384
freestanding
birth
centers
in
the
united
states.
There
are
none
in
nevada,
there's
one
birth
center
that
is
on
the
brink
of
opening.
Q
However,
because
there
has
been
no
definition,
there
have
been
some
struggles
and-
and
my
co-presenters
are
going
to
speak
a
little
bit
about
that
shortly,
currently
of
all
the
us
birds,
bird
centers
make
up
a
little
less
than
one
percent.
This
data
has
has
been
updated
by
aabc
and
it's
now
estimated
that
it's
a
little
bit
closer
to
one
percent,
which
is
a
200
increase
in
bursts
in
the
last
10
years.
Q
As
previously
mentioned,
the
us
currently
ranks
really
poorly
in
relation
to
their
peers
in
regards
to
maternal
health
outcomes,
maternal
mortality
outcomes
and
infant
mortality
outcomes.
Most
notably,
the
racial
disparities
in
these
outcomes
is
tremendous.
Q
As
previously
stated
again,
black
women
are
exponentially
more
likely
to
not
only
not
survive
childbirth
but
to
suffer
severe
disability
following
childbirth.
Q
We
know
I
want
to
go
back
to
this
slide
for
a
second
and
just
say,
we
know,
there's
a
an
abundance
of
literature
that
says
that
implicit
bias
in
the
medical
community
plays
into
this.
I
think
there
have
been
several
high-profile
stories,
including
serena
williams,
in
which
it's
become
clear,
that
in
in
the
medical
community,
for
whatever
the
reason
black
women's
explanation
of
their
pain,
is
not
believed
by
providers.
Another
reason
why
this
relational
approach,
this
midwifery
approach
to
care,
is
so
important.
Q
Looking
at
some
of
the
value
we
see
in
birth,
centers
nationally
about
42
percent
of
births
are
covered
by
medicaid
in
nevada.
That's
looking
more
like
60
to
70
percent
of
births
are
covered
by
medicaid.
Q
Again,
looking
at
the
cost
savings,
most
recently
washington
d.c
engaged
in
a
medicaid
study
to
estimate
about
how
much
it
would
cost
how
much
it
would
save
save
them
to
utilize
birth
centers
for
their
low
intervention
medicaid
births.
What
they
found
was
they
saved
around
1163
dollars
per
birth.
Now
these
numbers
that
I'm
reporting
for
nevada
are
have
are
not
would
would
not
be
entirely
the
case
and
and
nevada
would
have
to
do
a
study,
a
cost
study
to
see
how
much
would
save
the
state.
Q
However,
just
based
on
my
estimates
with
41
233
birth
certificates
issued
in
just
clark
county
in
2020,
and
if
we
estimated
that
60
percent
of
those
births
from
just
clark
county
were
medicaid
funded.
If
every
medicaid-funded
birth
in
clark
county
went
to
a
birth
center
and
we
saved
the
same
as
washington
dc,
it
would
save
the
state
over
28
million
dollars
now,
realistically,
that
that
is,
we
know
that
it
would
be
closer
to
one
one
percent
of
birds
coming
to
birth
centers.
Q
However,
that
would
still
save
the
state
a
few
hundred
thousand
dollars,
just
in
clark
county
alone,
additional
implications
for
medicaid.
We
know
that
if
more
pregnant
beneficiaries
use
birth
center
services
during
the
prenatal
period
for
the
duration
of
their
care,
they
are
more
likely
to
experience
better
outcomes.
Q
In
those
first
few
days,
our
first
few
weeks
postpartum
using
the
strong
start
approach.
The
american
association
of
birth,
centers
versus
national
data,
found
that
in
a
number
of
maternal
and
infant
health
indicators,
the
strong
start
approach
was
was
much
more
successful
and
produced
better
outcomes.
Q
Specifically
in
relation
to
race.
I
think
it's
important
to
note
that
using
the
strong
start
model
with
african-american
birthing
persons
reduced
the
cesarean
rate
by
more
than
half.
Q
Again
to
close
out
the
birth
center
model
of
care
benefits
it's
time
intensive,
but
it
is
relationship
based.
It
includes
referrals
to
needed
resources,
health,
education,
emotional
and
mental
health,
support
midwives,
see
fewer
clients
per
day
than
obs
and
as
such,
they're
able
to
really
connect
with
their
clients
in
a
different
way
and
and
support
these
positive
outcomes.
Q
I
actually
had
two
birth
center
deliveries
in
colorado.
What
made
the
decision
for
me
is,
I
read
the
the
outcomes
about
the
black
maternal
health
crisis
and
I
did
not
feel
safe
going
to
a
hospital.
I
wasn't
certain
that
that
would
be
a
place
where
my
needs
would
be
met
and
my
voice
would
be
heard.
Q
I
went
to
an
ob
for
my
initial
appointment.
When
I
found
out,
I
was
pregnant
and
having
had
a
history
of
miscarriage,
having
had
a
previous
loss,
the
ob
said
to
me:
okay,
well,
where
you're
sitting
right
now,
you
it
looks
pretty
good.
You
have
like
a
10
to
15
chance
of
miscarriage.
At
this
point,
the
next
day
I
had
an
appointment
with
a
midwife
at
the
birth
center,
and
she
said
to
me
after
I
told
her
my
story.
Q
She
said
well
knowing
what
we
know
you're
looking
at
like
an
85
to
90
chance
of
having
a
healthy
baby
and
the
difference.
In
that
perspective,
the
emphasis
on
the
life
that
I
was
growing
was
what
what
it
took
for
me
to
realize
that
having
a
birth
center
birth
is,
is
what
would
make
me
feel
like
an
empowered,
educated,
knowledgeable
person
in
in
during
my
delivery.
Q
Q
All
of
the
photos
in
this
presentation
were
taken
during
birth
center
births
and
I'd
like
to
thank
the
incredible
community
of
birth
workers
in
nevada
and
across
the
country
who
work
to
empower
their
clients
and,
finally,
my
partner,
who
allowed
me
to
quit
a
tenured
faculty
position
to
pursue
this
work
here
in
nevada.
Thank
you
for
your
time.
P
Yes,
we
do,
we
have
miss
genevieve,
burkett
and,
I
believe,
miss
april
clyde.
R
Speak
hi,
I'm
april
clyde.
I
am
started
my
maternal
child
career
at
sunrise
hospital
in
1998
as
a
labor
and
delivery
nurse.
So
I
have
been
doing
maternal
child
here
in
southern
nevada
for
a
long
time.
The
pictures
that
you
saw
the
birth
center
pictures
of
the
building
and
inside
are
actually
my
birth
center.
That
is
hopefully
weeks
away
from
from
opening
the
I
have
started
the
process
of
first
getting
laws
changed
and
now
opening
the
center,
but
actively
working
to
get
the
center
open
for
the
last
three
years.
R
It
has
been
such
a
challenging
process.
I
honestly
don't
know
that
anybody
following
behind
me
without
some
law
change
is
going
to
be
able
to
see
it
happen.
It
has
most
of
that
three
years
was
working
through
city
fire
state,
we're
still
working
with
the
health
department
kind
of
our
final.
So
you
see
the
birth
center
is
ready
to
go.
It's
stocked
with
medical
equipment
instead
of
using
the
commission
for
the
accreditation
of
birth
centers.
So
a
national
organ
organization
that
license
and
accredits
birth,
centers
think
hospital.
R
The
joint
joint
commission
that
accredits
hospitals-
they
are
the
experts
in
that
they
do
that,
rather
than
looking
toward
you
know
to
state
and
city
to
to
do
the
licensing
and
the
accrediting
what
it
is
left
for
birth
centers,
like
myself,
is
lots
of
people
arguing
and
not
understanding
what
we
are,
so
the
two
closest
templates
that
kind
of
fit
in
nevada.
What
a
birth
center
is
is
an
ambulatory
surgery
center
and
a
nursing
home.
We
are
neither
of
these
things.
We
don't
have
people
that
are
anesthetized.
R
R
We
have
an
agreement
with
with
a
collaborative
physician
and
and
in
our
case
umc
is
10
minutes
away.
R
So
there's
a
plan,
but
because
there
isn't
an
understanding
of
this
amongst
health
department,
officials
and
city
officials,
we
are
getting
met
with
very
things
that
are
really
delaying
and
that
are,
and
then
that
are
delaying
the
process
and
not
increasing
patient
safety.
R
And
so
it's
my
hope
that
we
see
that
I
that
no
one
else
has
to
go
through
the
journey
that
I
have
I
have
gone
through,
because
there
is
incredible
evidence
to
support
that
freestanding
birth,
centers
and
the
midwifery
model
of
care
increases,
maternal,
maternal
and
child
outcomes.
A
Thank
you
miss
clyde,
and
if
we
can
go
to
the
last
presenter,
assemblywoman
monroe
moreno,
I
think
it's
miss
burkett.
L
L
Yeah,
my
name
is
jenna
lee
burkett.
I
work
with
april's
clyde,
tara
and
april
really
have
covered
the
majority
of
you.
A
C
L
L
L
The
commission
for
the
accreditation
of
birth
centers,
our
accrediting
our
soon
to
be
accrediting
body
for
serenity.
Birth
center
goes
over
an
incredible
amount
of
thorough
review
of
birth
centers
before
they're
allowed
to
be
accredited.
L
We
provide
training
and
drills
and
safety
to
all
of
our
staff,
who
are
registered
nurses
and
certified
nurse
midwives,
who
are
required
by
the
state
of
nevada
to
be
at
each
birth
and
attend
each
birth,
and
I'm
just
grateful
to
be
a
part
of
it
and
was
a
beneficiary
of
of
april's
services
as
well.
So
that
is
that's
what
I
have
to
say
today.
A
Thank
you,
miss
burkett,
and
this
sounds
so
much
better.
Thank
you
for
your
patience
committee
on
trying
to
get
this
down
right.
Assemblywoman,
monroe
moreno.
Do
you
have
anything
further?
Are
you
ready
for
questions.
P
A
I
think
we
can
go
ahead
and
take
some
questions.
I
know
that
we
have
a
couple
other
bills
on
dr
on
deck
here,
so
I
want
to
make
sure
we
get
to
this,
and
I
know
we
have
quite
a
few
questions
on
here
and
I
trust
our
members
reviewed
that
documentation
prior
to
today's
committee
hearing.
I
know
that
they
are
all
very,
very
diligent
so
with
that,
I'm
gonna
actually
ask
the
first
question.
Thank
you
for
bringing
this
bill.
A
I
had
similar
like
friends
of
my
age
that
were
also
looking
and
were
able
to
go
to
birthing
centers,
and
so
I
was,
you
know,
obviously
disappointed
when
I
learned
that
that
was
not
an
option
for
me
in
clark
county.
So
I
appreciate
your
bringing
some
light
to
this.
Can
you
kind
of
explain
how
you
think
that
these
changes
in
this
bill
would
allow
for
birthing
centers
to
you
know,
become
more
prevalent
and
we
can
avoid
some
of
the
regulatory
like
confusion
that
ms
clyde
has
obviously
had
to
go
through.
P
Thank
you,
madam
chair.
This
is
assembly,
woman,
danielle,
monroe
moreno,
and
I
think
it
was
explained
really
good
by
ms
clyde
she's
had
to
jump
through
hoops
after
hoops
after
hoops
to
adhere
to
provisions
for
a
traditional
medical
center
that
she
is
not,
and
we
did
not
have
in
our
our
statutes
a
clear
and
defined
definition
of
what
a
birthing
center
is,
and
I
think,
by
putting
that
definition
within
our
nrs.
P
It
will
make
it
not
only
easier
for
her,
but
for
other
people
in
our
community
who
qualify
and
are
accredited
or
want
to
be
accredited
to
build
birthing
centers
and
give
options.
So
we
can
have
healthy
mamas
and
healthy
babies,
give
them
options,
but
I
think,
by
making
this
distinct
definition,
it
will
make
that
process
much
easier.
A
Babies
here
no
more
babies
here
we
if
we
can
go
next
to
assemblyman
matthews.
F
Yes,
thank
you
chairwin.
Thank
you.
Assemblywoman
monroe
moreno
question
for
either
you
or
one
of
your
co-presenters.
Perhaps
can
you
tell
me
how
many
other
states
have
this
licensing
and
regulation
of
birthing
centers
and
in
the
states
that
do
if
there's
any
kind
of
statistical
correlation
between
the
licensure
and
health
outcomes?
Thank
you.
Q
Yes,
currently,
40
states
have
active
birth,
centers,
and
the
findings
have
overwhelmingly
been
that
outcomes
for
birth
center
births
are
are
better
as
far
as
prenatal
care,
prenatal,
satisfaction,
labor
and
delivery.
Satisfaction
and
postpartum
support.
F
Q
This
is
this:
is
tara
reigns,
yes,
better
in
relation
to
their
peers
and
hospital
births,
and
so
the
studies
that
have
been
conducted-
and
I
have
a
few
of
them
available
at
the
end
of
the
presentation-
the
studies
that
I'm
referencing
many
of
those
studies
are
just
looking
at
outcomes.
Looking
at
birth
center,
birth
versus
hospital,
birth
or
birth
center,
birth
and
group,
prenatal,
support
versus
hospital
and
individual.
More
more
typical
prenatal
support.
C
Thank
you
chairwin
and
first
I
just
want
to
comment
that
I'm
super
excited
to
see
and
hear
you
guys
talk
about
centering
pregnancy
so
really
really
excited
about
that.
But
going
through
the
bill,
I
was
hoping
you
could
clarify
a
little
bit
for
everyone:
the
difference
between
a
freestanding
birthing
center
and
an
obstetric
center,
and
then
also
how
in
section
12.2
how
we
came
to
that
30
miles
within
a
hospital.
How
that
was
determined.
L
I
can
I
can
answer
genevieve
burkett,
so
a
freestanding
birth
center
is
a
birth
center
that
is
not
attached
to
a
hospital
and
the
state
of
nevada
and
determined
that
they
wanted
to
call
a
freestanding
birth
center,
an
obstetric
center
in
their
it
correct
me,
I'm
wrong
april
and
their
last
set
or
when
they
were
defining.
What
a
freestanding
birth
center
was
for
their
legislation.
R
R
Yep,
I'm
april
clyde
nurse
practitioner
but
yeah
the
obstetrics
center.
The
phrase
obstetrics
center
is
just
a
holdover
from
nrs.
I
think
it's
been
in
our
in
nrs
for
decades
and
it
just
didn't
get
changed
and
that
it's
the
and
it
was
before
freestanding
birth.
Centers
were
as
prevalent
as
they
are
now.
So
it's.
I
don't
think
that
it's
there
really
isn't.
R
There
isn't
a
difference
in
that
we're
talking
about
the
same
thing.
It's
the
problem
is
when
you
call
it
an
obstetric
center.
I
think
that
people
are
confused
because
freestanding
birth
center
is
called
out
in
functional
guidelines
and
other
regulatory.
It's
not
called
an
obstetric
center
in
other
states
or
another
regulatory
wording.
C
R
Correct
that
at
a
birthing
center
that
it
is
all
of
it,
it
is
its
care
through
what
we
call
the
birthing
year
from
you
know,
from
preconception
through
we
care
for
moms
and
babies
for
two
months
after
delivery
as
well.
C
Thank
you
and
you
could
you
explain
also
how
we
came
to
that
30
miles
of
a
hospital
for
the
birthing
center.
R
I
am
not
sure
so.
There
is
some
research
that
supports
this,
that
being
within
and
some
research
says
30
minutes.
Some
research
says
60
minutes
that
outcomes
are
better
when,
when
there's
that
distance
from
the
birth
center
to
and
specifically
to
a
tertiary
care
hospital,
so
a
big
you
know
a
big
hospital.
Q
This
is
tara
rains
for
the
record,
I'd
like
to
expand
on
april's
response
to
the
distance
question,
so
there
is
hot
off
the
press,
fresh
research
from
late
220
to
2019,
where
they
looked
at
distance
for
rural
birthing
people
to
hospitals
and
what
they
found
is
for
low
intervention
birds,
where
the
birthing
person
knew
in
advance
that
they
were
going
to
be
in
a
far
away
from
a
hospital
that
there
was
no
benefit
to
being
closer
to
the
hospital.
Q
So
the
the
the
key
to
that
would
be
making
sure
that
people
are
prepared
to
be
farther
from
a
hospital.
And
I
I
know
that
that
is
part
of
this
legislation.
But
it
would
be
phenomenal
if
it
wasn't
simply
because
birth
centers
are
poised
to
really
support
our
rural
communities
and
places
where
we're
finding
that
there
is
obstetric
care
deserts
in
nevada
and
so
having
that
anchor
to
a
hospital
could
be
limiting.
R
Much
to
speak
to
that
I've
had
a
home
birth
practice
and
I've
worked
in
hospitals
and
and
out
of
the
hospital,
but
I
have
many
families
that
travel
from
hours
away
in
nevada
to
to
birth
here,
because
there's
not
you
know,
there's
not
a
hospital
where
they
live.
A
K
Haven,
I
thank
you,
madam
chair,
and
and
thank
you
for
bringing
this
bill
forward.
One
of
my
questions
has
to
do
with
the
current
birthing
center.
That's
up
north
here
I
know
it's
not
a
freestanding
birthing
center,
which
I
believe
is
what
this
bill
was
addressing
is
just
the
freestanding,
but
I
just
want
to
clarify
on
the
record
that
there
would
not
be
additional
licensing
requirements
for
that
current
birthing
center.
R
K
It's
it's
my
understanding
that
there's
a
birthing
center
associated
with
renown
up
here
and
then-
and
I
am
from
down
south,
so
I'm
not
very
familiar
with
it,
but.
P
This
is
assembly
woman,
danielle,
monroe,
moreno,
chair
gwen
to
assimilate
hayfin.
P
O
Thanks
so
much,
I
appreciate
that,
and
so
I
think
that
the
first
line,
the
thing
that
was
most
interesting
to
me,
especially
when
we
talk
about
licensing
questions
and
like
where
people
fall
in
licensure,
is
that
they
can
fall.
You
know
we
can
only
regulate
what
happens
if
the
state
has
put
on
to
the
law
books
about
licensure,
and
then
we
say:
okay
you're,
within
the
scope
that
the
state
can
intervene.
So
I
thought
it
was
particularly
interesting
to
hear
on
the
testimony
that
you're
kind
of
living
between
two
different
licensing
types.
O
You
know
an
ambulatory
surgical
center
or,
I
believe
you
said
a
nursing
home,
but
we're
neither
one
of
those
things,
and
so
it
it.
It
is
hard
because
you
know
I
I
would.
I
guess
this
would
be
more
than
a
comment
than
a
question
like
what
what
we've
experienced
before
is,
and
I
don't
think
that
this
is
anything
that
miss
clyde
would
ever
do
so.
O
Please
don't
take
these
as
representations
towards
you,
but
you
could
see
someone
who
might
have
less
honorable
intentions
or
less
train
I'll,
say,
transparent
intentions
right
where
and
we've
seen
this
happen.
In
other
types
of
licensing
groups
where
people
start
practicing
and
because
we
don't
have
a
clear
law
about
what
they
can
and
can't
do,
we
can't
go
in
and
regulate
them
right.
O
We
had
this
problem
for
years
with
group
homes,
and
then
we
were
trying
to
define
in
group
homes
and
defining
group
homes,
because
our
state,
regulators
or
ombudsmans
would
walk
in
and
go.
You
look
like
a
group
home
and
they
say
well,
no,
I'm
not
because
here's
what
you
say
a
group
home
is
and
I'm
not
licensed
design
since
I'm
not
licensed.
You
can't
touch
me
right
and
so
then
we'd
have
to
like.
O
We
were
constantly
chasing
through
the
11th
session
and
the
13
session
and
through
the
17
session,
trying
to
get
these
people
onto
the
map,
and
so
one
thing
that
I've
always
appreciated
when
it
comes
to
saying
here's
a
clear
path
for
licensure
is
you
know
everything
that's
happening
in
your
community
and
everyone,
who's
willing
to
hang
out
a
shingle
and
be
transparent
is
known
and
we
have
a
better
idea
of
what's
happening
versus
just
you
know.
If
we
only
have
a
space
where
people
can
people
exist
ambiguously
without
state
oversight,
then
they
will
exist
there.
O
So
I
guess
that's
what
I
always
appreciate
when
we
talk
about
trends
in
a
community
is
if
we
think
it's
worthwhile
and
we
think
it
ought
to
be
done
safely,
then
we
ought
to
have
a
serious
conversation
about
regulations
and
licensure
and
how
we
make
ensure
that
it
is
done
safely.
That's
just
my
comment.
P
A
E
Thank
you,
madam
chair.
I
appreciate
the
opportunity
to
ask
a
question
and
I
appreciated
all
the
discussion
that
we've
had
so
far
and
all
the
excellent
questions
that
were
asked
just
to
be
clear.
I
did
my
ob
training
as
a
second
year
resident
at
la
county
general
as
an
md.
I
spent
two
months
down
there
delivering
babies
every
third
night,
where
we
literally
would
deliver
50
babies,
and
it
was
everything
wrong
that
this
bill
tries
to
solve
no
prenatal
care.
We
caught
them
as
they
came
in
the
door.
E
It
was
an
amazingly
intense
experience
and
I
was
pregnant
at
the
time
for
myself
when
I
chose
to
have
my
babies,
I
had
them
at
st
mary's,
where
they
have
wonderful
birthing
rooms.
Where
the
you
you
there,
you
do
have
someone
you
can
have
with
you.
The
baby
never
leaves
the
room,
and
it
was
a
wonderful
experience
for
me
not
unlike
unfortunately,
some
of
the
testimony
we
heard
today.
E
Having
said
all
that,
however,
I
have
some
questions
regarding
this
bill
in
particular.
First
off
someone
testified
that
that,
in
order
to
partake
in
this,
you
already
had
to
have
prenatal
care
or
you
couldn't
go
to
one
of
these
birthing
centers.
Is
that
correct.
Q
This
is
terrorist
for
the
record.
No
I'd
like
to
clarify
in
my
own
personal
story.
I
went
to
an
ob
as
I
was
trying
to
decide
if,
if
I
wanted
to
pursue
a
typical
route
versus
a
birth
center,
no,
the
birth
centers
provide
ob
care
and
in
many
cases,
birth
centers
provide
fertility,
support
and
well-person
care
for
folks
who
are
trying
to
conceive
okay.
Q
This
is
terrarians
again,
no,
it's
a
mixture.
There
are
some
who
are
for-profit.
Many
of
them
operate
as
non-profits,
so
it
just
depends
on
the
the
model
of
the
owner
as
an
operator.
E
So
there
are
some
non-profits
birthing.
Centers
then
affect
issues
like
people
walk
into
the
birthing
center
they're
gonna
have
their
baby.
Is
there
any
impala
violations
or
how
what
rules
do
you
have
to
follow?
Do
you?
Can
you
turn
somebody
away
question.
R
E
So
again
so
will
you
accept
medicaid
payments
and
do
you
affect
cash
payments
and
will
you
accept
somebody
who
has
no
means
of
payment?
Yes,.
R
And
this
is,
it
is
far
less
expensive
when
you're
comparing
vaginal
birth
to
vaginal
birth.
You
know
the
apples
to
apples
far
far
less
expensive
to
birth
at
a
birthing
center
and
we
accept
medicaid
and
we
do
accept
women
with
late
care
so
that
are
getting
that
are
beginning.
You
know
prenatal
care
in
their
second
trimester
or
even
their
third
trimester,
but
you
can't
like
a
hospital,
show
up
and
have
had
no
prenatal
care.
E
Well,
having
done
ob
out
in
rural
nevada,
which
is
far
away
with
no
backup,
I
know
that
birthing
can
be
a
wonderful
wonderful
experience.
It
was
something
that
I
felt
as
a
family
practice
doctor
to
be
a
complete
family
doctor.
I
needed
to
do
ob
at
the
same
time
and
we
would
select
our
low
risk
patients
at
the
same
time.
Unfortunately,
even
in
lovers
patients,
there
is
at
least
a
statistics
that
I've
been
looking
at
sitting
here
about.
20
percent
of
the
ones
that
I
just
looked
at
will
be
transferred
to
a
hospital.
E
That's
the
current
rate
that
I
just
see.
Nationwide
of
these
birthing
centers,
20
percent
will
ultimately,
even
in
the
low-risk
moms,
be
transferred
to
a
hospital
center
for
either
some
sort
of
assistance
with
delivery,
some
sort
of
medication
recovery.
How
do
you
deal
with
that?
How
do
you
deal
with
the
transfers?
Do
you
have
to
have
agreements
with
local
hospitals?
E
For
those
potential
we
know
will
happen
even
in
the
best
of
circumstances.
How
will
you
deal
with
those
pregnancies.
R
R
Most
of
those
are
happening
through
prenatal
care
that
someone
gets
gestational
diabetes.
Someone
has
high
blood
pressure,
someone
you
know,
and
they
just
they
become
not
a
candidate
for
because
what
we're
the
expert
in
is
we're
the
experts
in
normal,
which
is
the
vast
majority
of
pregnant
people
in
the
united
states,
but
that's
what
we're
the
experts
in
we
do
have.
So
speaking
for
our
practice,
we
have
a
collaborative
agreement
with
the
school
of
medicine,
ob
gyn
department,
so.
E
And
that's
when
you
so
you
have
an
agreement
with
another
center
and
will
there
be
any
requirement
for
the
other.
So
I
respect
what
you're
trying
to
do.
Will
there
be
a
requirement
at
all
that
there's
an
agreement
with
other
facilities
for
the
known
complications
or
the
the
safe
hand-off,
those
kind
of
things
so
that
the
transition
is
living
in
the
world
and
having
it
happen?
It's
important
that
you
know
that
when
it
does
happen,
you
have
that
that
hand
off
the
the
warm
hand
off.
Q
This
is
tara
raines.
Currently,
there
is
no
requirement
for
that
in
in
the
legislation,
and
I
I
believe
that
is
to
reduce
barriers.
I
think
what
other
states
have
found
is
that
some
of
the
hospitals
have
not
been
as
excited
as
we
are
to
see
birthing
centers
in
their
communities,
despite
the
the
positive
outcomes
associated.
Q
I
know
and
the
birthing
center,
where
I
delivered,
they
had
a
relationship
with
a
local
hospital,
and
I
was
encouraged
to
just
go
check
out
the
hospital
ahead
of
time
in
the
event
that
I
did
have
to
transfer
for
one
reason
or
another.
E
And
that
again
is
kind
of
where
I'm
going
with
this
question,
because
again
it's
that,
it's
that
safe
transfer
and
understanding
that-
and
one
of
the
arguments
for
this
bill
is
the
poor
outcome,
especially
as
you
quoted
in
in
certain
groups
of
women,
and
I'm
just
wondering
if
it's.
If
all
these
requirements
are
there
you're
almost
pre-selecting,
that
these
women
won't
qualify
for
this
birthing
center.
So
I'm
just
wanting
to
make
sure
this
is
really
helping
solve
a
problem
that
you're
truly
trying
to
solve.
Q
So
I
would
also
add
this
terrorist
again.
I
would
also
add
that
one
of
the
key
pieces
of
the
birthing
center
is
that
prenatal
education,
that
nutrition
support,
that
mental
health
support
and
we
found
that
with
those
pieces
going
back
to
that
that
centering
model,
particularly
with
the
group,
but
with
these
pieces
in
place
it
reduces
morbidity,
and
so
if
I
am
a
super
low
income,
very
very
young
birthing
person-
and
I
am
getting
this
nutrition
support-
I'm
getting
support
around
healthy
choices-
I
may
not
develop
that
gestational
diabetes.
That
would
risk
me
out.
Q
E
Almost
done
madam
chair,
if
I
might
liability
so
what
type
of
liability
coverage
as
mandated
for
these
services.
R
So
all
of
the
the
providers
that
have
to
be
there
at
every
birth
the
way
the
lies
now
is
a
nurse
practitioner
nurse
midwife
at
every
birth
and
an
rn
at
every
birth.
The
nurse
practitioner,
the
and
the
practice
is
required
to
carry
a
1
million
3
million
policy.
This
is
the
same
as
ob
gyns
or
any
other
yeah.
E
Right
that
was
my
limit.
One
million
three
million
to
do
to
be
in
that
was
expensive.
Obviously,
final
question:
if
I
might
madam
chair
sorry
in
these
birthing
centers
since
you're
asking
to
be
outside
and
again
I
like
the
concept
I
like
having
somebody
there,
I
I
did
that.
I
mean
I
stayed
by
their
side.
E
So
the
thing
about
it,
you
have
to
require,
if
you're,
outside
the
other
requirements
for
an
obstetrical
center
or
a
hospital,
are
you
going
to
be
required
to
have
resuscitative
equipment
there,
emergency
equipment
that
post
hemorrhage
those
kind
of
things,
and
will
you
be
able
to
use
a
pit?
Will
you
be
able
to
use
anything
if
they
don't
stop
other
than
massage
of
the
uterus?
What
what
will
you
be
required
to
have
in
your
facility.
R
This
is
april
kind
again,
I
love
all
of
these
questions,
who
knew
I
was
going
to
get
a
doctor
at.
So
these
are
great
questions,
and
so
the
commission
for
the
accreditation
of
birth,
centers,
assembly,
women,
titus,
think
jayco
think
the
joint
commission
for
hospitals.
They
require
everything
you
just
described
that
we
have
to
have.
So
all
of
those
we
have
to
have
a
crash
cart,
a
recess
dave
equipment
for
mom
and
baby.
R
We
have
an
aed
machine,
all
of
the
anti-hemorrhagic
medication,
you
just
that
all
has
to
be
there
that
that's
that's
all
in
a
requirement
for
accreditation,
very.
E
Good
all
right,
thank
you
for
the
bill.
Thank
you
for
the
litany
of
questions
that
you
allowed
me,
madam
chair,
and
I
appreciate
it.
Thank
you.
A
I'm
sure
miss
clyde
is
enjoying
being
able
and
rains
are
enjoying
being
able
to
answer
these
questions
as
well.
If
we
can
go
next
to
assemblywoman
krasner.
S
Thank
you
very
much
chairwind
for
this
opportunity
to
ask
a
question
and
it
it
goes
off
a
little
bit
of
dr
titus's
question.
So
what
will
these
birthing
centers
have
the
equivalent
of
a
nicu
neonatal
icu?
They
have
the
equivalent
of
those
services
for
babies
born
in
fetal
distress,.
R
It's
excellent
question:
we
have
the
same
ability
as
a
level
one
a
level
one,
I'm
sorry
a
level
three
nicu,
so
a
well
and
well
nursery.
This
is
what
most
rural
hospitals
in
nevada
in
nevada.
Still
even
some
of
the
some
of
the
hospitals
were
suburb
hospitals
in
southern
nevada
have
so
we
can
take
care
of
well
newborns.
We
do
have
resuscitation
equipment,
but
we
don't
see
preterm
babies.
You
have
to
be
at
least
37
weeks
to
deliver
at
the
at
the
burst
center,
everybody
that
is
so
the
rns.
R
The
nurse
practitioners
are
all
neonatal
resuscitation
trained,
and
so,
if
there
was
a
resuscitation,
we
also
have
protocols
with
the
three
fire
departments
that
could
be
responding
if
there
was
a
situation
where
a
mom
or
baby
needed
to
be
transported
to
the
hospital
that
we
have
will
be.
In
fact,
it's
happening
next
week
where
we're
running
drills
with
them
for
transport.
S
So
you
know,
I
know,
there's
different
levels
of
hospitals
in
regards
to
their
immediate
and
urgent
care
that
they
can
provide
and-
and
this
sort
of
goes
to
section,
12
sub
2
talking
about
the
freestanding
birthing
center
must
be
located,
30
minutes
from
a
hospital
that
offers
obstetrics
and
emergency
services.
S
I
was
when
I
gave
birth
to
my
first
son.
I
was
super
healthy,
only
ate
nutritious
foods,
vitamins
very
healthy,
low
risk,
pregnancy
and
I
was
offered
to
because
I
was
a
low-risk
pregnancy.
I
give
birth
in
a
hospital,
it
was
kind
of
in
a
rural
area,
but
they
didn't
have
the
highest
level
of
services
for
a
child
born
in
fetal
distress,
and
they
were
15
minutes
from
a
hospital
that
did,
and
I
just
opted
to
go
for
the
hospital
that
had
the
experts
and
and
the
whole
bells
and
whistles,
and
doctors
and
nurses.
S
Thank
goodness
because,
even
though
I
was
a
low-risk
pregnancy,
my
son
was
born
in
fetal
distress
and
he
would
have
died.
My
doctor
told
me
in
15
miles
from
that
hospital
to
the
other
one
he
would
have
been
dead.
Who
would
have
known?
I?
I
was
low
risk
and-
and
this
really
concerns
me
so
if
you
could
please
address
those
concerns.
R
So
in
a
birth
center,
babies
are
getting
monitored.
Can
I
have
you
state
your
name
again
april
clyde,
I'm
a
nurse
practitioner
with
serenity
birth
center,
so
there
has
been
a
lot
of
research
comparing
what's
called
intermittent
fetal
monitoring.
So
this
is
what's
done
at
a
birthing
center,
where
moms
can
be
in
any
position
they
can
be
in
the
water
and
we're
listening
and
there's
a
protocol,
a
national
protocol
of
for
this
listening
and
and
then
compared
to
what's
done
in
the
hospital
continuous
fetal
monitoring.
R
So
people
in
the
united
states
are
more
familiar
with
this,
where
there's
a
wire
there's
a
little
belt
on
mom
and
that's
connected
to
a
wire
and
a
machine.
That's
continuously
monitoring
the
baby's
heart
rate
there
haven't.
There
has
not
been
found
a
difference
in
mommy
outcomes
or
baby
outcomes,
with
continuous
monitoring
and
intermittent
monitoring.
R
There
will
be
babies
that
need
to
be
resuscitated.
Just
like
there's,
you
know
you're
in
labor
room,
one
and
they're
planning
for
a
normal.
You
know
vaginal
delivery
and
you
know
that
there's
distress
and
mom
gets
moved
either
to
the
operating
room
or
that
staff
come
in
for
resuscitation
of
baby.
These
same
protocols
are,
are
planned
for
and
that
we
have
emergency
services
and
emergency
personnel
there
to
recess
a
debate
resuscitate
a
baby
if
necessary.
R
We
also
aren't
waiting
for
emergencies
to
happen
if
babies
are
not
tolerating
labor.
Well,
if
we're
hearing
you
know
decelerations
in
the
heart
rate
we're
going
to
the
hospital
and
we
have
oxygen
and
emergency
equipment
to
be,
you
know
to
be
taking
baby
to
you,
know,
mom
and
or
baby
to
the
hospital.
H
I
don't
really
have
any
particular
question.
I
just
want
to
commend
you
all
on
your
presentation
and
the
bill
and
the
amendment
which
is
fantastic
and
novel
great
job.
This
is
really
really
wonderfully
written
and
well
thought
out.
H
I
also
just
want
to
say
that
having
had
three
kids
at
home
and
doing
all
of
the
research
and
every
one
of
those
children
and
the
variety
of
like
health
that
I
had
as
a
as
a
pregnant
woman,
which
I've
shared
some
of
on
here,
probably
too
much
information
for
most
people,
you
know
where
you
choose
to
birth
is
really
kind
of
an
intuitive
choice
and
assemblywoman
krasner.
H
You
used
your
intuition
to
decide
where
was
the
best
place
for
you
to
birth
and
really,
I
think
that
the
idea
of
options
is
kind
of
directed
at
exactly
that
that
women
we
should
trust
women
and
their
bodies
and
their
I
their
their
intuition
and
willingness
to
listen
to
themselves
and
take
in
information
and
understand
what
the
risks
are
for
them
and
their
babies
and
give
them
the
opportunity
to
make
those
choices
themselves.
This.
H
This
really
is
about
like
that
that
right
to
be
a
parent-
and
I
think
I
really
commend
this
bill
sponsor
and
the
folks
who
are
advocating
for
this
and
the
people
who
are
standing
up
these
kinds
of
facilities,
because
you
guys
you
are
enabling
women
and
birthing
people
to
to
do
what's
best
for
them
and
their
families.
And
so
thank
you.
A
Thank
you
and
with
that
I
think
this
is
a
good
starting
point
to
go
ahead
to
the
lines
to
testimony
in
support
opposition
and
neutral
of
this
bill
broadcast
services.
Can
we
go
to
the
lines
to
begin
testimony
in
support
of
assembly
bill
287?
I
would
remind
callers
to
please
clearly
state
your
name
for
the
record
before
speaking
and
please
limit
your
testimony
to
two
minutes.
A
I
know
that
we
it
two
minutes
goes
by
fast,
and
I
would
also
encourage
people
to
submit
any
written
comments
as
well
within
48
hours
of
today's
hearing
and
without
let's
begin.
G
G
G
N
Afternoon
sharon
nguyen
members
of
the
committee
for
the
record.
My
name
is
katie
ryan
k-a-t-I-e-r-y-a-n
and
I'm
assistant
director
of
nevada
government
relations
for
dignity,
health,
saint
rose,
dominican,
I'm
calling
in
opposition
today
to
ab287,
and
I
provided
a
letter
on
behalf
of
saint
rose
and
our
chief
medical
officer,
dr
rob
buslis,
which
describes
our
issues
with
the
bill.
We
want
mothers
to
have
their
babies
in
a
comfortable
setting,
but
we
also
want
to
make
sure
that
those
settings
are
as
safe
as
possible
and
close
to
a
higher
level
of
care
if
needed.
A
And
with
that,
I
will
turn
this
back
over
to
assemblywoman
monroe
moreno
for
any
closing
remarks.
I
don't
know
if
your
co-presenters
have
closing
remarks.
P
Thank
you,
chairwin
and
committee
for
giving
us
the
opportunity
to
present
this
bill.
I
think
assemblywoman
peters
looked
at
my
notes
because
she
completely
stole
my
clothing
remarks.
There's
absolutely
nothing
else
that
I
can
say.
I
see
birthing
center
as
a
another
options
for
for
mamas
and
women.
We
should
trust
women
is
what
what
they
want
to
do
with
their
bodies
and
where
they
want
to
give
birth
to
their
babies
if
it's
at
home
in
the
living
room
in
a
pool
in
a
hospital
or
in
a
birthing
center.
A
A
A
I
think
we
have
buffy
joe
akuma
and
chief
deputy
district
attorney
in
washoe
county
district
attorney's
office,
as
well
as
gabriel
carr
juvenile
master
in
the
sixth
judicial
district
court,
who
will
be
here
to
present
our
bills.
So
I
will
turn
this
over
them.
Welcome
and
welcome
to
hhs
and
begin
when
you
are
ready.
B
Thank
you
so
much
and
good
afternoon,
I'm
madam
chair
and
assembly
committee
members.
Thank
you
so
much
for
the
opportunity
to
meet
with
both
of
with
all
of
you
today
I
I
am
gabrielle
carr
and
I
serve
currently
as
the
6th
judicial
district
court,
juvenile
family
and
court
family
master,
and
I
also
serve
as
chair
for
a
subcommittee
of
the
community
improvement
program,
which
is
part
of
the
nevada
supreme
court.
B
That
was
created
to
create
this
bill,
and
I
have
is
in
my
presentation
today,
two
things
just
one:
a
brief
introduction
of
the
presenters
that
are
with
me
today
and
then
a
brief
overview
of
what
this
committee
was
created
for
and
why
it
even
came
into
existence.
So
I
appreciate
that
you've
been
listening
to
a
lot
today
and
I
will
do
it
as
briefly
as
I
can,
even
though
just
about
my
team
and
my
presenters
as
the
chair.
B
I've
also
been
practicing
family
law
and
related
cases,
including
child
dependency,
for
about
25
years
and
now
on
the
bench.
So
I've
covered
it
from
all
aspects
of
dealing
with
representing
the
parents,
the
kid
representing
the
child
welfare
agencies
and
now
actually
overseeing
these
cases
and
also
with
me
as
a
co-presenter.
Today
I
have
miss
buffy
okuma,
as
mentioned
she
is
the
chief
deputy
district
attorney
for
washoe
county
and
also
available
with
us
today.
B
To
answer
questions
is
chief
deputy
district
attorney,
jan
hanrahan,
from
clark
county,
so
you
have
washo
clark
and
the
rurals
represented
by
our
presenters
today,
and
just
to
give
you
a
brief
overview
of
why
and
how
we
got
here.
So
I
mentioned
the
community
improvement
program,
that's
through
the
nevada
supreme
court
and
that
program
was
created
to
allow
all
of
the
districts
within
the
state
to
come
together
and
work
together
as
team
to
improve
outcomes
for
children
in
child
welfare
cases.
And
so
this
can.
B
This
team
of
cip
in
stakeholders
involves
judges
and
masters,
attorneys,
social
workers,
guardian
ad
litems
administrators,
nevada,
supreme
court
staff
and
that's
managed
and
controlled
by
retired
nevada,
supreme
court
justice,
nancy
sata.
So
we
have
every
year
this
meeting,
where
we
all
come
together
called
our
cic
summit
and
all
the
teams
come
into
one
place
and
we
talk
about
how
to
do
things
better,
and
I
decided
to
stand
up
in
front
of
the
team
and
in
september
of
2019
and
said,
justice
sata.
B
Okay,
I
guess
I'm
going
to
be
cheering
this
committee,
so
I
reached
out
to
all
of
the
stakeholders
that
attend
these
meetings
throughout
the
districts
and
created
a
team,
and
I
have
shared
that
with
your
staff.
But
if,
with
permission
for
madam
chair,
I'd
like
to
share
that
participant
list,
so
that
you
can
see
who
we
have
in
this
team,
no.
B
Thank
you.
So
this
is
just
simply
a
list
of
all
of
the
stakeholders
that
were
contacted,
including
others
that
joined
this
subcommittee.
Along
with
me,
and
luckily
I
had
miss
buffy
okuma
join
me
as
the
co-chair
of
this
committee,
and
we
have
been
meeting
for
approximately
a
year
every
month,
sometimes
every
week
to
come
together
and
see.
What
can
we
do
to
address
all
the
issues
we're
having
under
chapter
432b?
B
I
believe
that
you
all
may
have
a
copy
of
this
document,
so
I
don't
want
to
spend
too
much
time
on
it.
I
just
wanted
you
to
see
that
we
have
representatives
from
the
nevada
supreme
court,
the
state
of
nevada
all
jurisdictions,
except
for
the
judicial
district
and
including
our
director
for
the
court
appointed
special
advocates
or
casa
program
here
in
nevada.
B
In
these
cases
before
child
welfare
agency
can
remove
a
child,
you
have
to
have
a
warrant
from
the
court.
Well,
that
warrant
process
has
is
different
for
every
jurisdiction.
So
part
of
our
goal
in
this
was
to
codify
the
need
for
a
warrant
and
make
it
more
uniform
so
that
the
districts
could
have
a
greater,
more
uniform
application
of
that.
B
A
No,
that's
fine.
I
just
remind
her
to
please
state
your
name
for
the
record
before
speaking.
D
We
identified
as
a
group
a
number
of
areas
that
we
wanted
to
address,
pursuant
to
our
agreement
for
everybody
to
have
consensus
on
what
we
were
going
to
work
on
and
we
had
a
pretty
short
time
frame.
We
got
started
a
little
bit
late.
We
decided
on
several
topics
and
then
we
ended
up
narrowing
those
down.
There's
a
few
kind
of
heavy
lift
topics
that
we
weren't
able
to
get
consensus
on
to
move
forward.
D
D
D
Master
carr
mentioned
the
the
court
of
appeals,
opinion
the
the
first
ninth
circuit
opinion
actually
came
out,
one
in
1999
and
one
in
early
2000,
so
it
was
on
the
radar
in
nevada
for
quite
a
while,
and
it
ultimately
resulted
in
washoe,
county
human
services
agency
being
sued,
and
thus
the
opinion
that
master
carr
is
referencing
during
that
time
period
between
the
early
2000s
and
when
that
lawsuit
occurred.
D
There
was
conversations
all
the
time
about
the
need
for
a
warrant
and
the
response
was
always,
but
we
don't
have
any
process,
there's
all
kinds
of
processes
in
place
for
criminal
cases,
but
it
hadn't
been
applied
in
the
child
welfare
world
until
the
early
2000s.
D
So
there
it
was
a
struggle
to
get
the
process
in
place,
and
I
will
say
that
the
implementation
across
the
state
of
nevada
was
extremely
slow
and
disjointed,
and
we've
talked
for
years
about
trying
to
get
the
warrant
process
codified
in
432b
so
that
we
all
one
can
not
have
to
patch
together
a
bunch
of
case
law
to
figure
out
what
is
required,
but
two
to
try
and
be
a
little
bit
more
consistent
from
jurisdiction
to
jurisdiction,
but
at
the
same
time
recognizing
the
differences,
and
I
think
we
accomplished
that
with
section
one.
D
So
that's
section
one
of
the
bill
section
two
of
the
bill.
It
was
just
a
conforming
change,
so
really
nothing
to
mention
there
with
regard
to
section
3
of
the
bill
again,
nothing
significant
in
that
one.
It
just
provided
for
some
clarification.
D
Section
4
of
the
bill
also
a
conforming
change
to
recognize
the
warrant
process.
When
we
get
to
section
five,
we
added
this
one
word,
but
it's
a
really
powerful
word.
We
added
the
word
that
we
would
have
jurisdiction
in
any
county
where
a
child
is
domiciled.
D
I
can't
tell
you
how
many
cases
we
get
in
nevada
just
for
some
edification.
We
have
three
separate
child
welfare
agencies
under
three
separate
jurisdictional
overlays
in
washoe
county,
it's
handled
by
the
washoe
county
human
services
agency,
with
the
district
attorney's
office,
representing
them
in
clark
county.
D
The
cases
are
handled
by
the
clark
county,
child
protective
services,
division
again
with
the
clark
county
district
attorney's
office
representing
them,
and
then
in
all
the
rurals
it
the
cases
are
handled
by
the
division
of
child
and
family
services
with
the
attorney
general's
office
as
their
legal
counsel,
though
they
don't
participate
in
the
actual
hearings
until
it
gets
to
a
termination
phase.
D
So
it's
a
little
bit
disjointed,
but
far
better
than
it
was
back
in
the
90s
with
that,
when
we
have
jurisdictional
issues
and
in
the
north,
often
between
carson
city
and
washoe
county
and
there's
a
few
similar
situations
down
in
the
south
oftentimes,
we
will
have
a
family
that
lives
in
carson
city,
but
the
child
is
born
in
washoe
county
generally
at
renown
because
of
the
specialized
services
that
renown
offers
interesting,
that
we
came
up
just
after
the
birthing
center
bill.
D
D
So
when
you
have
a
newborn
baby,
they
don't
really
reside
in
the
hospital,
but
they're
certainly
found
there,
but
they've
never
resided
anywhere
else,
and
so
we
have
situations
where
washoe
county
has
had
to
take
action
on
that
case
and
go
to
court
in
washoe
county
and
then
go
through
a
big
long
process
to
transfer
the
case.
To
carson
city
from
washoe
county
to
dcfs
and
all
the
while,
it's
taking
up
time
and
the
parents
could
just
be
getting
services
by
adding
the
word
domicile.
D
We
have
got
a
lot
of
case
law
that
says
a
newborn
child
is
domiciled
where
their
parents
reside
takes
care
of
that
problem.
So
it
was
a
simple
little
word
that
we
talked
about
a
lot
in
our
committee,
but
one
that's
really
powerful
and
will
help
that
situation.
A
lot
section
six
clarifies
and
expands
a
provision
about
persons
with
a
special
interest
in
child
welfare
cases.
We
have
a
lot
of
parties
or
parties
than
in
typical
family
law
case
family
law
case.
You
often
have
mom
dad,
maybe
grandparents
and
mom.
D
In
child
welfare
cases
we
have
of
often
a
mom
and
mom's
attorney,
dad
and
dad's
attorney
the
children
and
their
attorney,
the
casa,
the
social
worker
and
their
attorney.
And
then
we
have
a
handful
of
other
people
who
are
who
are
involved,
like
the
foster
parents
or
certain.
D
So
this
provision
in
the
statute
indicates
that
if
a
person
is
designated
as
a
person
with
a
special
interest-
they're
not
a
party
to
the
case,
but
they
are
entitled
to
have
notice
of
any
hearings
notice
of
what
the
permanency
plan
is
for
the
child
and
an
opportunity
to
provide
input
about
that
permanency
plan
and
an
opportunity
to
provide
input
to
the
court
in
court
proceedings.
So
it
does
trigger
some
additional
protections
with
that
it
had
always.
D
We
we've
always
struggled
since
the
very
beginning
of
putting
that
in
with
how
does
a
person
get
designated
the
statute
never
said,
and
so
we
would
constantly
have
various
family
members,
former
foster
parents,
all
kinds
of
people
filing
motions
in
our
cases
and
we're
like
well
they're,
not
a
party,
and
we
can't
open
the
floodgates
to
have
even
more
parties
in
all
of
our
cases.
D
So
we
amended
that
to
identify
that
a
court
can
designate
somebody
the
foster
parent
is
in
court,
they
generally
they're,
always
notified
of
it
and-
and
somebody
can
just
say,
hey
judge.
We
think
they
should
be
designated
so
that
they
get
all
of
these
extra
protections
or
a
relative
comes
to
the
court
proceeding
and
says
hey.
I
would
like
that
designation
so
that
I
can
get
these
extra
protections.
D
We've
had
situations
where
a
former
foster
parent
was
designated
as
a
person
with
a
special
interest
and
a
year
has
gone
by
and
they're
not
involved
in
the
case
anymore,
but
we
have
to
continue
to
notice
them
because
there
was
never
a
provision
for
them
being
undesignated,
so
we
cleaned
that
one
up
so
seven
updates
and
clarifies
what
is
in
existing
law
right
now,
when
we
have
what
we
call
either
a
protective
custody
hearing
or
72-hour
hearing.
If
a
child
is
placed
into
protective
custody,
the
agency
has
to
provide
noted
parents.
D
It
was
an
open
question
as
to
what
efforts
do
they
have
to
make
when
we
can't
find
the
parent
so
that
that's
just
one
of
the
things
that
we
takes
up
a
lot
of
time
in
our
proceedings
when
we're
all
arguing
over
what
happens
if
the
parent
couldn't
be
found.
D
It
also
updates
the
provision
and
modernizes
it
somewhat,
because
it
used
to
the
current
existing
law
says
that
if
we
don't,
if
we're
not
able
to
find
the
parent
and
either
personally
serve
them
or
serve
them
over
the
phone
or
orally,
that
the
social
worker
had
to
post
notice
on
their
door.
D
We
were
really
concerned
about
that,
because
we've
had
a
case.
I
got
sued
four
times
because
the
notice
blew
off
the
person's
door,
and
so
they
said
that
they
didn't
get
proper
notice
and
a
whole
host
of
us
were
were
caught
up
in
that
we
also
were
miss
okuna.
A
Yes,
sorry
to
interrupt
you,
I
see
that
you
are
kind
of
going
through
this
section
by
section.
I
trust
that
all
of
our
members
have
read
the
bill
to
prepare
for
today's
hearing.
I
know
that
they
have
done
so,
and
I
know
that
they
have
some
questions.
Do
you
want
to
open
up
for
some
potential
questions
on
the
potential
amendments
and
then,
if
it's
necessary,
you
can
give
your
reasoning
as
to
why
the
committee
wanted
to
do
that.
Absolutely.
D
So
yeah
there
were
just
a
few
more
sections,
but
to
the
extent
that
we
want
to
jump
right
into
questions,
we're
happy
to
answer
any
of
them.
I.
A
Think
we
would
like
to
do
that.
I
know
we
have
some
committee
members
that
have
another
committee
coming
up
at
four
o'clock,
so
I
want
to
make
sure
that
they
are
able
to
ask
their
questions
if
they
have
them.
Thank
you
for
that
presentation.
I
will
just
start
off
by
saying,
first
and
foremost
that
looking
at
the
page
of
I
believe
it's
45
people
on
that
list
of
people.
A
I
know
that
you
guys
meet
so
regularly
and
the
idea
that
you
have
consensus
from
that
many
lawyers
is
a
feat
in
and
of
itself
that's
probably
worthy
of
like
a
proclamation
to
celebrate
as
well.
So
with
that,
I
will
go
to
our
first
question.
I
have
a
question
from
assemblywoman.
C
Gorla,
thank
you
chairwin
and
I
apologize.
This
is
not
my
world
of
legal,
and
so
I
had
a
quick
question
about
section
one
subsection
one,
because
it
just
wasn't
making
sense
to
me.
It
talks
about
that.
The
designee
may
request
that
the
court
issue
a
warrant
to
place
a
child
in
protective
custody
and
then
it
kind
of
fast
forward
to
if
not
immediate,
in
the
time
it
would
take
to
to
obtain
a
warrant.
C
D
Thank
you.
So
the
way
the
federal
law
and
case
law
has
come
out
is
that
basically,
you
have
to
have
a
warrant
unless,
in
the
time
it
takes
to
get
a
warrant,
the
child
would
suffer
or
potentially
suffer
harm,
and
so
this
provision
allows
us
to
get
a
warrant
when
we're
able
to,
but
it
leaves
open
the
possibility
of
if
you
are
not
able
to
get
a
warrant
in
that
time.
The
example
I
often
give
is
a
three-year-old
who's
found
outside
alone.
D
You
can't
leave
that
child
to
go,
get
a
warrant,
and
so
that
would
be
an
exigent
circumstance,
but
otherwise
we
would
need
to
get
a
warrant.
D
Under
the
new
rules
of
civil
procedure,
it
clarifies
under
their
accounting
days
that
if
it
doesn't
specify
otherwise
it
would
be
calendar
days,
and
so
this
one
would
be
calendar
days
and
the
reason
for
that
is
because
sometimes
we
know
where
the
family
is,
but
then
after
we
get
the
warrant,
they
they
disappear.
So
sometimes
the
agency
needs
some
time
to
try
and
find
them.
Although
the
court
can
make
that
a
shorter
window,
if
they
choose.
O
I
do
madam
chairwoman,
and
I
appreciate
that,
and
I
actually
I
I
realized
we're
racing
the
clock
here
in
that
we're
going
to
start
losing
members.
But
I
thought
what
might
be
helpful
is
because
we
know
that
right
now
we're
building
the
legislative
record
that
will
be
reflected
upon
for
this
law
and
there
was
so
much
thought
into
it.
O
So
I
was
going
to
suggest
that
it
might
be
helpful
to
upload
under
exhibits
the
minutes
from
the
meeting,
because,
knowing
that
we
might
not
be
able
to
kind
of
do
a
deep
walk
through
on
the
bill,
I
thought
that
the
minutes
might
help,
at
least
in
living,
in
our
legislative
record
or
the
the
justification
of
the
bill
or
to
help
flesh
out
understanding
and
what
thinking
was.
I
appreciate
assembly
woman,
gorilla's
question
because
I
had
the
same
kind
of
question
of
like
for
the
legislative
record.
O
What
would
be
a
clear
example
of
reasonable
cause
in
the
time
frame
that
you
would
be
looking
to
define
in
statute
versus
an
unreasonable
example,
and
so
the
child
on
the
roadway?
You
know
pyramid
highway
kind
of
a
thing
where
you
gotta
scoop
them
up
really
quick
great
example.
Would
you
give
an
example
of
one
in
which
you
would
say,
okay
workers
out
there
in
the
field,
it
would
be
a
clear
example
of
would
not
meet
the
standard
for
the
warrant.
D
Sure
assemblywoman
benitez
thompson,
the
most
common
case
that
we
see
where
parents
are
found.
They
are
found
to
be
under
the
influence
of
substances
and
a
child
is
present,
but
the
child
is
not
at
immediate
risk
at
that
moment
for
the
worker
to
be
able
to
step
out
most
of
our
warrants
we
can
obtain
by
phone
and
so
for
the
worker
to
be
able
to
step
out
and
out
of
the
immediate
scene
and
apply
for
the
warrant
over
the
phone
and
get
the
warrant.
That's
probably
the
most
common
thing
that
we.
A
See,
thank
you
and
you
know
I'm
not
sure
if
the
community
improvement
pro
program
subcommittee
maintains
minutes.
But
if
you
do,
I
would
ask
you
to
provide
those
to
committee
staff,
so
we
can
make
them
a
part
of
this
legislative
record
because
they
know
that
you
had
several
meetings
with
your
subcommittee
members
and
other
participants
in
developing
these
recommendations
in
this
proposed
piece
of
legislation.
O
And
so
I'm
just
wondering
because
I
don't
know,
I
see
that
with
the
warrant
there's
a
10-day
process
and
that
when
you
go
the
actual
protective
order,
that's
a
72-hour
process.
So
I'm
guessing
it
sounds
like
this
has
evolved
through
haste
law
or
through
practice.
But
I
was
wondering
if
you
could
tell
us
a
little
bit
about
10
days
seems
like
generous.
D
So
we
had
a
lot
of
discussions
about
the
timing
of
how
long
a
warrant
could
be
valid.
The
10
days
is
for
how
long
you
can
have
to
execute
the
warrant,
not
how
long
you
have
after
you've
placed
the
children
into
protective
custody.
It
also
is
expected
that
that's
the
outside
limit.
That's
why
we
have
that
provision
in
there,
so
that
there's
a
time
when
we
know
this
warrant
is
no
longer
valid.
D
It's
our
expectation-
and
I
do
know
that
in
in
the
second
judicial
district
court,
it's
anticipated
that
the
court
will
in
granting
the
warrant
have
a
shorter
time
period.
Right
now,
more
often
than
not,
our
court
is
limiting
the
validity
of
that
warrant
to
72
hours,
but
if
we
have
a
good
reason,
we
can
get
an
extension
up
to
10
days
based
on
that
example,
like
we
said,
sometimes
the
family,
flees
and
you're
trying
to
find
them,
and
that
gives
you
some
time
to
do
that
perfect.
T
Jan
hanrahan
chief
deputy
district
attorney
in
the
clark
county
district
attorney's
office,
I'm
with
the
juvenile
division,
doing
child
welfare
cases,
and
I
was
leading
the
committee
that
put
together
the
warren
statute.
I
just
wanted
to
add
that
we,
the
10
days,
also
takes
into
account
what
we
have
down
here,
a
lot
and
I'm
sure
washoe
does
as
well
the
kind
of
situation
that
led
to
the
case.
That
requires
us
to
get
warrants,
which
is
a
baby
born
in
a
hospital
drug
exposed
or
to
a
mom
who's,
not
appropriate
to
take
that
child
home.
T
Sometimes
those
babies
are
in
the
hospital
for
a
period
of
time,
and
you
know
they're
in
the
hospital
being
taken
care
of
somebody's
supervising
mom
being
in
there,
and
so
it
kind
of
contemplates
that
period
of
time
that
the
baby's
in
the
hospital
too.
We
may
not
need
to
make
the
official
removal
right
away.
T
A
A
Seeing
none,
I
will
go
to
the
lines
to
start
hearing,
testimony
and
support
opposition
and
neutral
of
this
bill
broadcast
services.
Can
we
go
to
the
lines
in
start
testimony
in
support
of
assembly
bill
426,
I
remind
callers
to
please
clearly
state
your
name
for
the
record
as
well
as
limit
your
testimony
to
two
minutes.
G
G
F
Good
good
afternoon,
my
name
is
deshaun
jackson,
d-a-s-h-u-n
j-a-c-k-s-o-n.
I
serve
as
the
director
of
children's
safety
welfare
policy
with
the
children's
advocacy
alliance.
We
stand
in
support
of
assembly
bill
426.
We
believe
that
this
bill
is
crucial
to
the
safety
and
the
welfare
of
children,
and
we
also
believe
that
this
bill
would
save
lives
and
would
also
help
with
many
of
the
issues
that
these
youth
face.
Thank
you
all
so
much
for
considering
this
deal.
G
N
K-E-N-D-R-A-B-E-R-T-S-D-H-Y
and
I'm
with
the
washoe
county
public
defender's
office.
First,
I
want
to
thank
the
committee
for
hearing
this
bill.
As
you
heard,
our
state
is
in
great
need
for
reforming
our
dependency
statutes.
We
appreciate
the
times
that
everyone
put
together
with
this
committee.
We
were
involved
in
the
process
of
negotiating
and
the
bill
that
you
see
before
you
is
the
product
of
a
carefully
negotiated
and
crafted
legislation
that
took
a
significant
amount
of
time
from,
as
you
heard,
a
lot
of
stakeholders.
N
G
F
F
Good
afternoon,
chair
members
of
the
committee,
my
name
is
john
mccormick,
john
last
name
m-c-c-o-r-m-I-c-k,
I'm
the
assistant
court
administrator
at
the
nevada
supreme
court
aoc,
and
while
our
court
improvement
program
has
been
mentioned
several
times,
I
just
wanted
to
call
in
and
register
our
support
for
this
bill
and
put
our
appreciation
of
all
the
work
that
the
committee
members
did,
particularly
our
co-chairs.
Thank
you.
A
We
have
any
callers
in
opposition
to
assembly
bill
426.
If
we
do,
can
we
begin
that
testimony
now.
G
N
B
This
is
gabrielle
carr.
If
I
may
very
briefly,
thank
you.
Thank
you
all
so
much
for
your
time.
I
will
just
say
that,
because
of
the
extensive
nature
of
these
committee
meetings
and
that
there
were
three
subcommittees
within
it,
meaning
that
we
don't
have
minutes
from
the
meetings
we've
had.
However,
I
would
be
happy
to
provide
a
summary
of
what
the
the
need
of
it
was
why
we
did
what
we
did.
A
Thank
you
miss
carr.
If
we
can
get
those
minutes,
I
think
it
would
be
very
good
to
like
supplement
the
record,
though,
regarding
the
changes
to
the
432
b
sections
that
you're
proposing
and
again
the
amount
of
work
and
the
time
that
you
all
have
put
into
this,
to
gather
the
kind
of
consensus
that
you
have
among
public
defenders
and
district
attorneys
and
courts
and
court
admin
is
really
commendable.
So
with
that,
I
will
go
ahead
and
close
the
hearing
on
assembly
bill
426.
A
A
A
Seeing
none,
I
will
go
ahead
and
close.
This
here
are
close
the
or
end
the
during
the
hearing
of
assembly,
health
and
human
services
today,
and
we
will
see
you
all
on.