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A
Wonderful
good
afternoon,
everyone
thank
you
for
getting
on
so
promptly
good
afternoon.
Welcome
to
the
assembly
committee
on
health
and
human
services.
I
will
open
the
meeting
for
today.
Members
again,
please
keep
on
your
cameras,
so
we
know
that
we
have
a
quorum
and
that
everyone
is
present
and
again,
please
mute
your
microphone
when
you're,
not
speaking
to
minimize
any
background
noise.
Madam
secretary,
please
call
the
role.
A
A
A
C
A
Here,
if
our
members
that
are
not
present,
if
we
can
mark
them
present
when
they
arrive,
I
will
also
try
to
keep
an
eye
on
them.
I
know
that
the
agenda
had
said
at
the
adjournment
floor
and
I
know
we
were
wondering
if
there
might
be
some
deadlines
or
it
might
take
a
little
longer
today.
So
I
appreciate
everyone's
promptness
here
today
and
I'd
welcome
our
audience
joining
us
on
this
virtual
meeting.
We
have
one
bill
hearing
today,
so
I'm
just
going
to
jump
right
into
it.
A
Today
we
are
going
to
be
hearing
assembly,
bill
44,
and
I
will
now
open
the
hearing
on
assembly
bill
44..
This
bill
revises
provisions
related
to
county
hospitals,
and
we
have
with
us
today
mr
van
gaaling,
the
ceo
and
miss
pip
general
counselor
at
university
medical
center,
and
I
will
turn
it
over
to
you
all
to
begin
when
you
are
ready.
D
D
D
Umc
provides
a
number
of
services
that
are
home
and
one
of
a
kind
here
at
umc,
including
the
level
one
trauma
center.
The
lions
burn
care
center,
the
center
for
transplantation,
children's
hospital
of
nevada
at
umc
and
a
level
two
pediatric
trauma
center
umc
retains
more
than
4
000
employees.
It
cares
for
hundreds
of
thousands
of
visitors
and
patients
each
year.
D
Over
the
last
year,
umc
has
played
an
integral
role
in
the
states
of
nevada's
cobit
19
response
as
being
the
state's
leader
in
combat
19
testing.
We
performed
over
well
over
a
million
pcr
tests
with
result
turnaround
times
less
than
12
hours,
and
now
we've
moved
on
to
the
next
chapter
in
the
covet
19
vaccination
efforts
and
as
of
right
now,
we've
done
four.
I'm
sorry
41
400
vaccines.
D
Today
we
are
here
to
discuss
assembly
bill
44,
a
bill
that
is
sponsored
by
clark
county
and
supports
the
mission
of
umc
to
provide
the
highest
level
of
care
to
our
patients,
while
ensuring
exceptional
quality
and
meeting
our
goal
of
being
good
taxpayer
stewards
of
the
taxpayer
dollars.
This
bill
serves
for
two
purposes.
D
D
The
governing
board
members
are
appointed
by
clark
county
commission,
which
remains
as
umc's
hospital
board
of
trustees
and
umc's
ultimate
authority
in
2013.
The
commissioners
had
the
foresight
to
recognize
the
importance
of
having
dedicated
members
of
the
community
with
specialized
knowledge
and
skill
sets
to
provide
oversight
and
guidance
with
respect
to
daily
management
hospital
operations.
D
Furthermore,
it
can
lead
to
delays
informing
our
board
earlier
than
we
would
like
whether
proactive
measures
that
can
serve
to
improve
the
quality
and
care
as
we
as
we
have
discussed
to
be
clear.
This
bill
does
not
allow
for
the
governing
board
of
any
public
hospital
to
take
action
or
make
decisions
in
a
closed
session.
D
We
have
heard
from
various
stakeholders
since
our
bill
was
introduced
and
throughout
these
discussions
with
our
stakeholders,
we've
understand
that
the
original
language,
perhaps
of
the
bill
early
on,
was
a
little
too
broad.
It
did
not
clearly
address
those
near
narrow
instances
where
closed
sessions
and
deliberations
are
needed.
D
The
amendment
before
you
today
is
narrowly
tailored
to
meet
our
needs.
Furthermore,
we
understand
the
nevada
rural
hospital
partners
out
there,
in
the
association
and
throughout
the
state,
are
seeking
to
introduce
an
amendment
that
will
extend
these
opportunities
to
rural
county
hospitals
as
well,
so
they
can
better
address
patient
safety
and
quality
concerns.
D
This
bill
will
also
serve
as
a
safeguard
to
the
nevada
taxpayers,
an
investment
in
their
own
public
hospital
by
allowing
a
public
hospital's
governing
board
to
proactively
address
any
potential
legal
or
regulatory
issue,
adverse
outcomes,
costly
fines
or
protracted
litigation
can
be
avoided
again.
This
bill
is
not
against
transparency.
D
D
A
D
I'm
sorry,
yes,
they
are
correct.
I
was
on
mute
as
you
request,
but
yes.
D
Chair
mason
van
holly
for
the
record
ceo
of
umc,
and
we
are
that
is
correct.
A
And
members
I
did
have
committee
staff
email,
those
out
this
morning
at
least
the
rural
hospital
ones.
I
believe
that
that
one
went
out
this
morning
and
they
are
both
on
nellis,
that
you
can
see
under
exhibits
right
now.
A
Oh
excuse
me,
and
let's
see
what
was
I
going
to
say,
I,
there
are
a
couple
of
questions,
a
lot
of
questions.
Actually,
so
I
will
go
ahead
and
start
with
assemblywoman
thomas.
E
D
For
the
record
mason
van
gaaling,
ceo
of
umc,
no
man
that
is
not
correct,
we
are
always
have
been.
In
fact,
we
celebrated
our
90
years
of
serving
our
community
this
year
and
will
continue
for
the
next
90
years
as
a
public
institution
operating
for
the
clark
county
community.
D
E
Yes,
sir,
with
the
way
that
I'm
reading
this.
E
The
board
of
hospital
trustees,
which
would
be
the
county
commissioners,
would
still
be
as
to
say
the
board
of
governors
hospital
governor
bosses.
Am
I
correct.
D
Yes,
ma'am
for
the
record
mason
van
gaaling,
again
ceo
of
umc
correct.
That
is
not
changing.
It
is
just
codifying
back
in
2013
clark,
county
established,
umc's
governing
board,
and
we've
done
really
great
things,
and
I
can
take
you
through
all
those
highlights,
but
the
hospital
board
of
trustees,
which
are
the
clark
county
commissioners
when
they
put
their
hat
on
when
it
comes
to
hospital
business,
they
are
serving
as
hospital
trustees.
D
They
have
oversight
of
the
umc
governing
board,
which
are
those
community
members,
and
we
have
we
meet
monthly,
but
also
there's
four
subcommittees
under
that
board:
a
finance
committee,
a
quality
committee,
a
strategy
committee
and
hr
and
those
meet
often
throughout
the
month
and
serve
as
kind
of
the
overall
operating
oversight
of
the
hospital,
but
those
governing
board
members
report
to
the
hospital
trustees,
which
is
our
clark
county
commission.
Hopefully
that
answered
the
question
so
nothing's
changing
there.
It's
just
codifying
it
in
nevada,
revised
statute,
which
is
already
in
park
county
ordinance
here.
E
Thank
you.
So
how
does
this
affect
the
union.
D
Mason
van
gaaling
for
the
record,
ceo
of
umc,
there
is
no
direct
impact
or
indirect
impact
to
the
union.
As
I
mentioned,
the
any
deliberations
or
votes
or
decision
making
always
would
come
out
in
a
public
session,
and
we
have
great
attendance
at
our
meetings
with
the
union.
D
I
meet
with
them
frequently
our
team
meets
with
them
frequently,
but
I
I
can't
see
any
direct
or
indirect
impact
to
our
union
partners
here
at
university
medical
center.
Just
I
can't
even
come
up
with
an
example,
but
it's
just
not
there,
but
they're
always
welcome
to
our
meetings
and
they
do
frequently
attend
the
governing
board
meetings.
The
subcommittees,
but
also,
if
there's
any
hospital
trustees,
business
matters
that
goes
in
front
of
clark,
county
commissioners
they're
often
there
supporting
or
making
their
voice
heard,
but
usually
I'm
there
with
them
side
by
side.
E
D
Yes,
ma'am
mason
van
hollen
for
the
record
again
those
those
would
always
be
handled
at
the
county
commission
level
again
with
the
hat
of
as
a
hospital
trustee,
and
they
they're
very
good
at
switching
over
for
clark,
county
commission
business
to
hospital
business,
and
there
would
be
no
changes
to
bylaws
that
would
come
out
of
a
closed
session
within
umc
and
again
all
those
decisions.
D
Any
votes
are
always
done
in
the
public
eye,
properly
noticed
vetted
out
and
discussions
made,
but
nothing
that
I
I
would
see
that
would
directly
impact
the
union
with
this
particular
bill.
E
All
right,
thank
you,
sir,
and
just
one
more
question
in
your
presentation
you
had
mentioned.
If
I
understood
it
and
and
heard
you
correctly,
you
said
that
this
ab44
would
prevent
litigation.
How?
How
is
that
possible.
D
Well,
I
think
so.
It
would
certainly
not
prevent
litigation.
It
would
perhaps
minimize
protracted
litigation,
and
I
think
that's
the
word-
and
I
was
probably
reading
too
fast
there,
but
it
would
allow
us
to
inform
our
board
much
sooner
of
any
potential
regulatory
litigation
issues
sooner
than
later
to
be
able
to
address
those
matters.
A
No
problem,
I
think
next
we
have
a
question
from
vice
chair,
peters,.
F
Thank
you
chair
and
my
question
is
kind
of
along
the
same
lines.
It's
my
understanding
that
there
are
already
some
protections
for
closed
meeting
discussions
in
certain
cases
and
scenarios.
Can
you
talk
about
those
and
the
difference
that
this
bill
will
make
to
those
scenarios
and
why
this
is
particularly
needed?
If
we
already
have
some
protections
for
other
specific
scenarios.
D
Mason
van
gaaling
for
the
record,
ceo
of
umc,
some
of
the
women.
I
may
lean
on
our
general
counsel,
a
little
a
little
bit
on
this
one.
There
are
instances
when
we
can
go
into
a
closed
session
session,
whether
it's
and
particularly
into
litigation
matters,
but
I
I
prefer,
if
our
general
counsel,
ms
pitts,
answer
that
question.
So
I
get
you
the
the
exact
answer,
you're
looking
for.
So
I'm
going
to
step
aside
and
she's
right
here
next
to
me,.
G
G
Here
we're
trying
to
put
that
ability
under
nrs
450,
which
is
specific
to
running
a
hospital
so
that
we
can
follow
our
specific
procedures
related
to
that.
The
medical
board
has
done
similar
in
nrs
630,
where
they
make
references
to
this
and
following
their
procedure,
as
has
state
mental
health
and
the
behavioral
health
commission
statute
under
nrs
433.
G
Sure
I
think
one
of
the
big
areas
and
long
recognized
and
part
of
why
we
made
the
amendment
to
specifically
reference
review
committees
under
nrs.
49
is
practitioners
reviewing
practitioners
peer
review,
so
it's
important
when
you're
doing
peer
review
in
a
hospital
in
a
hospital
setting
with
physicians,
for
example,
that
it's
the
peers
reviewing
each
other
the
hearing,
the
witnesses,
the
testimony
all
get
done
with
with
a
panel
of
their
peers.
F
G
F
G
It's
long
been
recognized
in
nevada
that
to
get
physicians
to
participate
in
peer
review
to
to
look
at
the
the
role
of
other
physicians
and
instances
where
maybe
you
know
they
didn't
do
the
best
or
there
was
an
adverse
outcome
they
review
each
other
at
that
level
again
and
it's
at
the
hospital
it
was
actually
involving
our
medical
staff,
which
is
not
a
independent
entity,
though
it's
under
umc,
it's
a
group
of
physicians
that
are
elected
that
meet
and
discuss
these
issues.
G
What
happens
and
what
happens
with
all
hospitals.
Frankly,
is
you
have
this
peer
review
at
the
medical
staff
level
and
with
a
fair
hearing
panel
of
the
peers,
but
the
ultimate
decision,
according
to
health
care
laws
and
regulations,
needs
to
be
approved.
So
the
the
medical
staff
or
the
fair
hearing
panel
may
make
a
recommendation,
for
example,
that
privileges
are
revoked.
G
It
has
to
go
up
in
every
instance
with
hospitals.
It
goes
up
to
the
board
to
approve
that
recommendation
here.
Our
board
just
happens
to
be
a
public
board,
so
if
the
public
board
had
questions
about
the
record
that
might
include
that
sensitive
information
that
was
at
the
peer
review,
they
would
be
doing
that
in
open
meeting
or
they
would
be
going
under
241
which,
again,
while
we
have
done
that
in
the
past,
and
can
continue
to
do
that,
it
doesn't
follow
the
same
procedure.
We
would
like
to
do
under
nrs450.
F
F
I
I'm
looking
at
your
amendment
and
it
says
the
example
provisions
to
discuss
matters,
including
without
limitation
limitation,
deliberation
of
the
character,
alleged
misconduct,
professional
competence
and
or
physical
or
mental
health
of
the
provider,
health
of
health
care.
So
that's
the
scenario
you're
talking
about
the
peer
review,
piece,
okay
and
then
the
second
is
reports
related
to
the
compliance
of
the
hospital
with
all
laws,
regulations,
rule
making
guidelines
of
the
centers
for
medicare
and
medicaid
services,
or
with
any
condition
of
participation
in
the
medicare
or
medicaid
program.
G
So
as
a
hospital,
obviously
we
are,
we
are
licensed
and
accredited
by
a
number
of
different
bodies
both
on
the
state
and
federal
level
and
to
be
cms
is
who
has
oversight
over
the
medicare
medicaid
program.
Obviously
umc
we
take
medicare
and
medicaid
and
to
to
be
able
to
take
medicare
and
medicaid.
You
have
to
follow
certain
rules
of
cms
and
their
conditions
of
participation.
G
They
expect
and
part
of
those
conditions
of
participation
is
that
you
have
a
fully
informed
board
and
that
you
are
bringing
any
issues
to
them
that
you
know
you're,
policing
yourself
much
like
in
the
peer
review
setting
where
physicians
are,
are
tasked
with
with
policing
themselves
in
a
hospital
that
is
a
cms
provider.
You
are
expected
to
police
yourself
and
then
report
those
issues
to
a
fully
informed
court.
G
F
Okay,
I
I
appreciate
you
entertaining
the
questions
and
talking
about
the
specific
scenarios
and
I'm
gonna
pass
on
for
other
questions,
but
I
may
have
more,
as
we
run
through
this.
Thank
you
sure
I'll
turn.
H
Thank
you
so
much.
My
question
is
under
still
under
section
one,
I'm
I'm
referring
to
the
amendment
now
so
section
one
sub
five,
so
I
want
to
make
sure
I'm
reading
this
correctly.
So
as
I
read
it
anything
that
any
of
the
conversations
and
then
the
supporting
records
and
transcripts
for
those
closed
meetings
will
they're
going
to
be
outside
of
that
five-year
rule
in
which
it
has
to
become
public,
so
they
will
indefinitely
remain.
Not
public
records.
Is
that
right.
D
Mason
van
howling,
a
ceo
of
umc
for
the
record,
correct
assemblywoman
that
those
would
would
become
public
after
five
years
unless
they're
privileged
and
confidential.
So
you've
read
that
correctly
and.
H
And
I
guess
I
worry
about
the
need
for
this.
In
our
other
statutes,
even
information,
that's
held
the
outside
of
public
record.
Even
some
of
the
most
sensitive
records
indeed
do
become
public
after
I
think
the
rule
is
about
30
years
or
so
so.
Could
you
talk
about
why
you
would
need
kind
of
a
perpetual
protection
around
this
information.
G
Hello
again,
susan
fitzgerald,
council
of
umc
for
the
record,
so
so
what
this
does?
It's?
Actually
because
the
five
years
was
already
in
nrs,
450
related
to
the
other
closed
session
that
we
had.
We
we
kept
that
for
this,
so
it
actually
is
saying
that
we
will
turn
it
over
in
that
fight
or
it
would
be
open
to
public
record
after
five
years
unless
it's
privileged,
which
is
how
existing
law
is
now,
if
it's
privileged
once
it's
privileged
for
all
time.
So
but
again
in
instances
where
it's
not
privileged.
G
Like
some
of
those
issues,
I
was
speaking
about
with
assemblywoman
theaters
cms
type
issues,
those
wouldn't
necessarily
hold
a
privilege,
and
that
would
be
subject
to
disclosure
within
five
years.
H
I
I'm
hearing
two
different
things.
I
just
want
to
make
sure
I
have
this
straight,
so
I'm
thinking
of
it
right.
So
I
see
that
you're
keeping
the
five
years
in
there
for
whenever
you
use
chapter
49.117
or
49.265
in
the
regular
way
that
you
use
it
now,
but
the
way
I'm
reading
the
bottom
end
is
that
if
it's
you,
if
your
board
deems
it
to
to
need
to
have
that
perpetual
protection,
then
it
will
fall
outside
of
that
five
years.
G
Susan
pitts
for
the
record:
yes,
I
believe
it
is
meant
to
be,
and
we
can
certainly
look
at
the
language
isn't
clear
on
its
face.
It
is
meant
to
be
that
everything
is
subject
to
to
being
open
in
five
years
unless
it
holds
a
privilege,
and
those
review
committees
under
nrs49
would
hold
that
privilege,
but
anything
else
would
not
necessarily
hold
that
privilege,
so
it
would
be
open.
So
we
are
not
looking
to
keep
that
perpetually
protected.
H
Okay,
I
guess
the
other
piece
I
that
I
still
had
some
more
questions
on
is.
I
know
that
you're
referencing.
H
And
talking
about
some
of
the
cms
conditions
of
participation,
I
guess
for
the
legislative
record.
I
would
feel
more
comfortable
if
you
could
get
to
us
what
specific
pieces
of
cms
data
collection
are
you
you're
concerned
about
so
much
of
that
is
aggregate
data
that
I
can't
think
of
a
time
when
you
are
really
getting
into
protected
health
information
at
more
of
the
aggregate
level.
H
Once
you
start
collecting
data
like
you
might
have
more
of
those
conversations
at
a
different
level,
oh,
but
I
think
I
need
help
with
what
you
mean
specifically,
so,
whether
it's
sentinel
events
or
and
then
kind
of
some
examples
of
where
you've
run
into
problems
with
the
data
collection,
piece
and
satisfying
cms,
and
then
the
inability
to
provide
information
because
of
a
sensitivity
to
public
health
records,
because
I
think
that
would
help
it
be
more
concrete
for
for
me
and
as
I'm
trying
to
understand
this,
I
do
have
some
additional
questions
in
section
two,
but
but
care
I'm
happy
to
kind
of
hold
on
to
them
and
let
other
let
the
conversation
continue.
A
I'll
go
ahead
and
go
to.
We
have
a
bunch
of
people
in
line,
so
if
it
doesn't
get
answered,
we
can
wrap
back
around
to
you
if
that's
okay,
assemblywoman
denise
thompson,
next
we'll
go
to
assemblywoman
titus.
I
I
want
to
circle
back
to
the
line
of
question
that
vice
chair
peters
had,
and
I
I
need
a
clarification
and
just
first
I'll
make
an
observation
having
been
on.
The
state
board
of
medical
examiners
have
been
having
been
on
the
state
peer
review
committee
when
that
was
in
existence
for
the
entire
state
and
having
served
as
chief
of
staff
or
hospital.
I
I've
been
involved
in
lots
of
peer
review
cases
and
they're,
not
bad
they're,
not
good
they're,
just
something
that
has
to
happen
for
standard
of
care,
and
we
just
for
clarification.
Members
there's
certain
forms
that
that
charts
get
peer,
reviewed
that
that
fall
into
the
category.
I
If
you
transfer
a
patient
out
of
the
er
in
24
hours,
if
obviously,
someone
dies
on
a
certain
stay,
if
somebody
leaves
ama
all
those
are
subject
to
peer
review
by
standard,
it
doesn't
mean
that
there's
anything
good
or
bad,
it's
just
they
fall
into
a
category
where
you
would
review
them,
not
necessarily
because
it's
bad
or
not
and
frequently.
I
would
look
at
those
and
just
say,
hey
that
standard
of
care.
End
of
story.
What
I'm
seeing
is
bills
where
the
question
is.
I
I
need
clarification,
these
laws,
this
law
already
exists,
nrs
450.140
exists
currently,
and
what
you're
seeking
to
do-
and
you
can
say
yes
or
no
on
this-
because
it
already
reads
the
board
of
ease
already-
has
this
ability?
What
you're,
adding
here,
is
language
x
or
any
hospital
governing
board,
because
it's
different
between
county
hospitals,
rural
hospitals
and
private
hospitals?
So
is
this
basically
adding
a
clarification
on
covering
for
all
hospitals,
not
just
those
with
a
board
of
hospital
trustees.
G
Susan
pitts
general
counsel
umc
for
the
record,
so
so,
yes,
I
think
the
language
you're
reading
from
is
really
just
a
clarification
that
where
a
board
of
hospital
trustees
can
go
into
closed
session,
so
can
its
appointed
and
delegated
governing
board.
Okay.
So
so
that's
just
trying
to
make
a
clarification
there
at
that
language.
I
Right
and
that's
that's
in
section
one
number
three
and
then
the
other
ones
going
to
section
six
again,
the
hot
the
board
of
trustees
are
is
already
in
that
section
two
are
going
down
and
what
we're
adding
here
in
counties,
because
many
counties
do
not
have
hospital
trustees
in
counties
with
a
board
of
hospital
trustees
and
where
they're
appointing
a
governing
board,
which
is
different
structure
just
clarifying
that
those
they
may
also
have
a
exercise,
powers
and
duty
delegated
to
the
governing
board.
So
there's
different
ways
of
organizing
hospital
structure.
I
G
For
the
record
absolutely-
and
I
I
think
if
you
look
at
the
language
in
section
two-
that
talks
about
nrs
451
75,
it
states
that
in
counties
in
which
the
board
of
hospital
trustees
appoints
a
hospital
governing
board,
the
governing
board
is
the
governing
body
of
the
county
hospital
when
exercising
powers
and
duties
delegated
to
the
governing
board
to
this
chapter.
So
what's
that
saying
is
whoever
is
the
delegated
authority?
G
Under
whichever
structure
you
are
under
when
they're
taking
action,
they
have
the
authority
to
take
the
action
because
it
throughout
nrs
it
uses
the
term
governing
body,
and
so
at
times
that
can
be
confusing
whether
or
not
you're
talking
about
the
board
of
hospital
trustees,
the
governing
board
either
one.
Whoever
has
the
authority
to
take
that
action
is
the
governing
body
for
that
that
matters.
I
Thank
you
for
that,
because
the
way
I
see
this
is
actually
clarifying
language
to
statute
that
already
exists
under
the
many
different
conditions
of
hospitals
that
we
have
to
allow.
Those
of
us
who
do
do
peer
review
to
do
our
job,
which
actually
does
indeed,
as
in
the
opening
statements,
will
help
for
patients
overall
outcomes
and
patient
protection.
So
thank
you
for
bringing
the
bill
forward.
Thank
you,
madam
chair.
A
Thank
you.
I
have
a
question
actually
before
I
go
into
it
because
it
kind
of
is
in
there
in
this
section
like
who?
What
does
the
privileged
and
confidential
mean
within
the
context
of
this
statute,
and
is
that
the
similar
language
that
you're
trying
to
capture
that
applies
to
other
hospital
facilities
right
now,.
G
Again,
susan
pitts
for
the
record,
so
in
the
amended
language
we
in
subsection
c,
we
specifically
called
out
nrs49,
because
you
know
the
various
stakeholders
asked
us
to
narrow
the
bill
and
get
to
what
we
were
really
trying
to
address
in
nrs
49
those
references
that
is
confidential
and
privileged
conversations
and
materials
that
are
used
in
those
peer
review
settings.
So
hopefully
that
answers
your
question.
A
It
does
a
little,
but
I
also
have
another
question
I
mean
it
appears
to
me
that
it's
the
actual
board
that
gets
to
determine
what's
privileged,
am
I
reading
that
incorrectly
or
is
that
kind
of
how
the
process
takes
place.
G
Again,
susan
pitts,
for
the
record,
I
I
do
not
believe
the
the
board
determines
what's
privileged.
If
it's
part
of
a
review
committee
proceeding
that
fits
under
nrs
49,
it
is
privileged
unless,
of
course
like
any
privilege,
it's
somehow
waived.
A
B
G
That
is
correct
again,
susan
pitts,
for
the
record.
What
we're
saying
is
we
wanted
to
because
existing
law
and
nrs
had
that
five-year
requirement.
If
we
went
into
closed
session
it
would,
you
know,
be
available
for
somebody
to
request
that
information,
the
supporting
materials
we
wanted
to
make
clear
that
that
would
apply
here,
but
if
something
is
privileged,
it's
still
going
to
maintain
that
privilege.
I
didn't
you
know
we
didn't
want
it
to
be
read
as
a
waiver
of
any
privilege
after
a
certain
period
of
time,.
G
Before
it
determines
that
it's
privileged
well,
no,
I
I
think
it's
again.
Susan
puts
for
the
record,
I
believe
it's.
It
was
intended
to
be
the
opposite,
but,
as
we
talked
about
earlier,
if
that
needs
to
be
clarified,
we
certainly
could
the
privilege
is
there
and
after
five
years
anything
that
does
not
hold
the
privilege
is
subject
to
request
for
disclosure.
A
J
Thank
you
chairwin
and
umc
for
your
presentation.
So
my
concern
is
the
change
that
you
made
in
the
language
and
I
just
clicked
off
so
please
bear
with
me.
While
I
go
back
to
what
I
was
reviewing
in
the
original
language
that
was
crossed
out
in
section,
oh,
I
lost
the
document,
I'm
sorry,
I
had
two
things
open
and
now
I
can't
find
it
in
the
in
the
original
language.
J
It
talked
about
healthcare
facilities
and
it
spoke
specifically
of
peer
review
and
then
you
cross
that
out,
and
so
I'm
like
a
little
concerned
about
that
because
now
it
see
it
just
says:
health
care
providers
which
in
my
opinion,
seems
broader
providers
of
healthcare
which
seems
broader
but
also
yeah.
It
seems
very
much
so
expansive
and
and
still
not
clear
to
me.
So
could
you
and
just
sort
of
talk
about
who
would
be
considered
these
providers
of
healthcare.
J
Go
ahead,
thank
you.
So,
when
I'm
looking
at
49117
and
it's
talking
about
committees
of
the
hospital,
the
ambulatory
care
surgical
center
and
all
that
here
would
be
the
people
that
are
working
for
those
organizations
that
are
providing
the
service.
Is
that
correct?
So
that
could
include
anybody.
Who's
working
inside
those
facilities
is
that
right.
G
Susan
pitts
for
the
record,
so
what
would
be
in
the
review
committee
could
involve,
I
suppose,
other
people
as
part
of
staff
is
that
I
want
to
make
sure
I'm
understanding
your
question
again.
The
review
committee
that
the
hospital
is
using
in
this
instance
is
for
its
licensed
professionals
and
we
can
certainly,
if
your
concern
is
to
let
it
not
include
something
specifically.
G
J
Okay,
thank
you
for
that.
I
do
I
am
concerned,
though,
and
I
think
I'm
just
to
to
highlight
my
concern
as
well
from
some
of
the
things
that
were
I
mentioned
before
the
the
committee
deciding
what
things
are
privileged
is
a
concern
of
mine.
I'm
also
concerned
about
a
statement
you
made
earlier
about
policing,
yourselves
and
and
the
need
for
this
to
be
confidential
in
some
manner.
I
have
a
concern
about
that.
J
I
think
often
that
hasn't
worked
for
the
general
public
when,
when
information
is
not
available
to
the
general
public
to
at
least
know
that
there
could
be
issues
in
a
particular
area
of
government,
because
this
is
all
being
paid
for
by
tax
dot,
payer
dollars,
and
so
this
you
know
umc,
although
it
is
providing
service,
it's
still
part
of
the
community.
J
We
own
it
because
we
pay
taxes
and
we
contribute
in
our
communities
for
that
hospital
to
run
not
fully,
but
we
have
a
a
stake
in
what
happens
at
umc,
and
so
self
policing
is
very
concerning
to
me,
especially
when
we
talk
about
the
people
who
are
on
these
committees
are
already
public
servants
to
their
elected
officials,
and
I
think
that
there
is
an
expectation
that
some
of
what
goes
on
would
already
be
open
to
the
community
and
I'm
I'm
just
kind
of
concerned
about
adding
another
layer
of
what
could
be
perceived
as
secrecy
to
a
review
panel
and
especially
when
you
already
have
a
tool
to
protect
people's
identity.
J
I'm
just
really
confused
about
I'm
I'm
just.
I
can't
get
clarity
on
on
on
the
necessity
for
this
additional
ability
to
meet
in
secret,
and
so
I
appreciate
it
if
you
have
other
information
that
you
could
share.
I'd
appreciate
that
very
much
to
help
clarify
for
for
me,
I'm
new
with
this.
This
is
my
first
time
hearing
anything
about
umc
and
how
you
all
want
to
do
this,
and
so
I
would
appreciate
it.
Thank
you.
G
Sure,
and
if
I
made
susan
pitts
for
the
record
just
to
clarify
when
I
use
the
term
self
policing,
that's
the
term
really
cms
and
cms
requirements,
they
require
all
hospitals,
public
or
private,
to
to
engage
in
those
types
of
activities.
So
that
was
what
I
was
referring
to
when
I
said
that.
So
thank
you
very
much
for
your
comment.
A
It
doesn't
look
like
it
so
at
this
time
I
will
go
to
broadcast
services
and
we
will
start
testimony
and
support
opposition
in
neutral
of
assembly.
Bill
44.
I'd
remind
callers
to
please
clearly
state
and
spell
your
name
and
limit
your
testimony
to
two
minutes.
Staff
will
be
timing,
each
speaker
to
ensure
everyone
is
given
a
fair
opportunity
to
speak,
and
with
that
we
will
begin
testimony
in
support
of
assembly
bill
44.
broadcast
services.
Can
we
have
our
first
caller
in
the
queue.
K
B
Thank
you,
joan
hall
j-o-a-n-h-a-l-l,
president
of
nevada,
rural
hospital
partners.
Thank
you
chairwind
for
allowing
me
this
friendly
amendment.
I
I
don't
know
if
you
want
to
go
over
that
now
or
if
you
just
want
my
support
for
this
bill
at
this.
A
B
Thank
you
so
nrhp
and
is
a
consortium
of
13
critical
access,
hospitals,
seven
of
which
are
county
district
hospitals
all
in
support
of
this
process.
B
The
national
quality
improvement
act
of
1987
laid
out
the
foundation
for
peer
review
all
those
years
ago,
recognizing
that
physicians
were
the
best
reviewer
of
physicians,
and
so
that's
why
they
put
this
process
in
place.
They
also
recognized
that
doing
this,
confidentially
and
in
a
safe
manner,
was
very
important
so
nationally
that
standard
has
already
been
set.
B
A
K
L
I'd
like
to
express
my
support
for
ab44
and
just
echo
what
miss
hall
from
nrhp
expressed,
but
to
just
add
a
rural,
but
in
mount
grant's
case
a
frontier
concern,
and
there
are
two
major
issues
that
I
wish
the
assembly
to
be
aware
of
one,
and
I
believe
miss
hall
was
referencing
that
but
in
a
in
any
hospital,
but
especially
a
small
one
like
ours.
That
level
of
candor
from
peer-to-peer
that
exists
in
peer
review
is
critical
to
getting
specific
information
about
any
provider
care
that
didn't
meet
the
standard
of
care.
L
If
you
will
and
if
that
were
to
be
public
I
or
disclosed
to
the
public,
I
I
don't
see
that,
at
least
in
my
experience,
you
have
much
candor
or
specificity
that
is
required
for
continuous
improvement,
so
that
once
again
we're
all
concerned
on
patient
outcomes.
And
if
we
can't
have
those
candid
conversations,
it's
going
to
be
difficult
to
have
the
the
improvements
necessary
to
provide
the
best
care
possible
for
our
patients.
L
Second
issue:
in
a
small
town,
a
very
small
town
like
hawthorne,
it
doesn't
take
much
for
people
to
put
two
and
two
together,
and
so,
if
this
became
public
knowledge
or
was
disclosed
no
matter
what
level
of
discretion
we
exercised,
people
will
soon
know
that,
though
that
was
my
grandmother,
the
patient
they're
just
they're
talking
about,
and
we
know
who
the
provider
was
as
well.
L
K
K
M
M
Yeah,
okay,
I
just
wanted
to
make
sure
that
they,
they
called
my
phone
number,
because
I
missed
that.
But
in
any
case,
as
long
as
I'm
here,
thank
you,
chairman
mcglinn
and
members
of
the
committee.
My
name
is
richard
carpell,
I'm
the
executive
director
of
the
nevada
press
association
and
I'm
also
testifying
today
on
behalf
of
the
nevada
open
government
coalition.
M
We
oppose
the
sections
of
assembly
bill
44
that
close
meetings
and
make
public
records
confidential,
and
we
don't
think
the
amendment
that
submitted
that
was
submitted
on
friday
helps
now.
Let
me
start
by
saying
my
understanding
is
that
there
are
other
members
of
our
coalition
who
are
in
communication
with
the
bill
proponents
and
that
we
will
be
meeting
with
them
to
work
through
our
issues,
so
we're
certainly
open
to
learning
more
but
based
on,
we
are
what
we
already
know.
M
It's
not
clear
why
any
of
this
stuff,
either
frankly
in
ab44,
even
the
stuff,
that's
already
closed
in
the
underlying
statute.
It's
not
clear
why
any
of
it
needs
to
be
secret.
So,
for
instance,
why
shouldn't
residents
of
the
state
be
allowed
to
participate
in
meetings
where,
where
the
compliance
of
their
local
public
hospital
with
federal
laws
is
going
to
be
discussed,
what
could
possibly
be
more
important
to
the
public
than
whether
their
local
hospital
is
complying
with
federal
law?
M
I
thought
let
me
also
mention,
if
I'm
understanding
the
peer
reviews
correctly,
they
should
already
be
covered
by
the
open
meeting
law
which
which
does
allow
public
bodies
to
discuss
personnel
matters
in
closed
section,
and
let
me
conclude
by
mentioning
that
the
proponents
appear
to
be
conflating
privileged
and
confidential
information
they're,
actually
two
different
things.
M
So
with
that,
I
will
just
again
say
we
are
opposed
to
assembly
bill
44.
Thank
you
for
letting
me
testify.
K
C
Thank
you
chairwin
and
members
of
the
committee
on
behalf
of
nevada,
justice
association,
I'm
an
unpaid
lobbyist
and
we
are
opposed
to
ab44,
simply
stated
the
the
intent
that
is
stated
in
this
hearing
does
not
mesh
with
the
language
of
the
bill,
nor
do
the
policies
align
with
the
language
of
the
bill
for
a
little
context.
C
The
reason
why
peer
review
committees
and
their
deliberations
are
non
not
disclosed
for
five
years
is
so
that
there
can
be
honesty
amongst
peers
and
not
retribution
amongst
peers
and
have
an
honest
review
that
does
not
that
policy
does
not
comport
with
the
bosses
of
the
company
or
the
hospital
reviewing
the
conduct
of
its
employees,
so
there
can
be
no
fear
of
reprisal
from
the
employees
against
the
governing
body
and
therefore,
there's
no
need
to
have
secrecy
or
lack
of
transparency.
C
C
No
disclosure
would
would
be
had
what
this
means
is
that
people
who
have
been
wronged
by
the
hospital
will
be
unlikely
to
find
out
any
relevant
information
to
why
they
were
wronged.
Who
is
responsible
for
the
wrong,
as
the
five
years
far
exceeds
the
statute
of
limitations
for
bringing
the
claim,
and
the
people
of
the
state
of
nevada
will
not
be
able
to
hold
their
elected
officials
accountable
for
being
good
or
bad
stewards
of
their
tax
dollars
and
administering
the
governance
of
the
hospital
and,
for
those
reasons,
there's
a
lack
of
accountability
in
this
bill.
C
A
Thank
you
for
providing
your
testimony
in
opposition
and
welcome
back
to
the
assembly.
If
we
could
go
to
our
next
caller
in
opposition
of
assembly
bill
44.
A
A
Seeing
none,
I
will
go
ahead
and
turn
this
back
over
to
mr
howling
to
make
any
closing
remarks.
D
Well,
thank
you,
chair
and
members
of
the
committee
for
your
time
today
and
hearing
the
bill
and,
as
mrs
pitts
we're
constantly
listening,
we
want
to
continue
to
work
and
to
refine
the
bill
as
needed,
and
I
think
that's
been
our
the
way
we've
operated
for
not
only
this
legislative
session,
but
the
previous
ones
as
well.
D
So
again
we'll
be
reaching
out
to
those
that
had
additional
questions
and
again,
I
think
just
underscoring
two
things
codifying
the
the
board
in
nrs
is
important
to
our
clark
county
and
then
also
just
narrowing
down
the
bill
to
make
sure
that
we're
able
to
have
discussions
and
in
the
dialogue,
but
always
we'll
do
things
in
open
session.
Any
actions
or
any
votes
will
always
be
done
in
open
session.
So
again,
I
appreciate
the
members
time
today
and
we'll
be
reaching
out
to
those
that
have
had
further
questions.
A
And
you
know
what
actually
before
I
let
you
go
before
I
close
this
hearing,
I
did
have
a
couple
of
follow-up
questions.
I
know
that
previously
assemblywoman
benitez
thompson
had
had
some
questions
about
section
two
and
I
don't
believe
that
they
were
answered
by
some
of
the
other
questions.
So
actually,
if
I
can
bring
her
back
on
to
ask
the
follow-up
question
regarding
section
two,
that
would
be
great.
H
H
So
I'm
just
I
don't
know
what
the
distinction
would
be
between
the
practice
right
now,
where
you've
got
a
governing
board
or
umc
has
a
governing
board
and
the
powers
and
duties
that
it's
using
without
it
being
specifically
stated,
I
guess
in
statute
or
that
someone
has
given
the
opinion
that
it
is
not
specifically
stated
in
statute
and
then
putting
chapter
the
provisions
of
section
two
into
place.
D
Mason
van
howling
for
the
record.
Thank
you
silly
woman
yeah.
I
think
it's
just
really
just
clarifying
again
since
2013
this
has
been
the
clark
county
ordinance,
as
you
heard
reference
to
nrs
450,
just
codifying
that
and
clarifying
whether
it's,
the
governing
board
governing
body
just
the
authority
that
that
would
clarify
in
section
two
so
again,
hospital
trustees
here
at
clark
county
are
elected
officials.
D
They
appoint
governing
board
members
to
oversee
the
governing
board,
but
also
the
subcommittees,
but
I
think,
as
ms
hall
had
mentioned,
this
would
help
other
district
hospitals,
other
public
hospitals,
just
clarifying
the
language
on
the
authority
and
putting
it
in
the
right
section
in
nevada,
veriz,
statutes,
450.
H
I
appreciate
that
so
there's
nothing
else.
I
need
to
hold
in
my
head
to
give
consideration
to
this.
It's
literally,
as
you
guys
see
section
two
just
to
clean
up.
There's
not
other
conversations
going
on
that.
I'm
I'm
from
you
know
northern
nevada,
I'm
not
in
clark
county.
So
I
don't
know
if
there's
some
some
other
consideration
I
should
be
holding
in
my
head.
D
No
mason
van
halen
for
the
record.
No,
I
think,
as
you
stated,
it's
just
kind
of
the
meat
and
potatoes.
It's
it's
an
important
piece,
but
it's
just
codifying
it
and
bringing
clarity
but
no
other
intents
around
that
just
make
it
more
nrs
450,
which
kind
of
defines
all
the
hospitals
here
in
the
state.
As
previous
mentioned.
H
All
right
and
then
just
real
quick
because
tying
back
to
section
one
in
the
amended
version,
the
sub
three.
You
do
have
the
word
any
in
here,
so
it
says
the
board
of
hospital
trustees
or
any
hospital
governing
board.
But
really
the
intent
is
just
the
hospital
governing
board.
You
can't
imagine
a
scenario
in
which
there
would
be
multiple
governing
boards.
H
D
Mesa
van
gaalin
for
the
record:
yes,
ma'am,
you're,
correct,
there's,
there's
no
other
intent,
certainly
not
here
in
southern
nevada
and
not
speaking
for
miss
hall,
but
because
structure
could
be
different
in
a
district
hospital
for
versus
a
public
hospital
county
hospital,
but
no
other
intent
there.
It's
the
the
you've
got
the
trustees
and
the
governing
board
here
and
that's
how
we
see
it
for
the
long
future
ahead.
A
Thank
you,
assemblywomanis
thompson,
I'm
sorry!
I
I
skipped
over.
You
come
wrapping
back
around.
Is
there
anyone
that
has
any
follow-up
questions
based
on
that
line
of
questioning
it
doesn't
appear
to
so
at
this
time
I
will
close
the
hearing
on
assembly
bill
44..
A
Thank
you
for
for
your
presentation
and
yes
at
this
time
we
will
move
into
public
comment
as
a
reminder
to
provide
public
comment.
You
have
to
register
online
at
the
legislative
website.
Again,
please
remember
to
clearly
state
spell
your
name
for
the
record
and
limit
your
comments
to
two
minutes.
We
will
be
timing
to
ensure
everyone
is
given
the
equal
opportunity
to
speak
broadcast
services.
Do
we
have
any
callers
on
the
line
for
public
comment.
A
Wonderful
at
this
time,
I
will
close
public
comment.
Are
there
any
other
comments
from
committee
members
before
we
adjourn
today
seeing
none?
I
will
adjourn
this
meeting.
Our
next
meeting
will
be
on
wednesday
march
24th.
Thank
you.