Carson City Lobby Day Dear Colleague, On March 3 and 4, the Nevada Chapter held its first legislative day in Carson City, and the event proved very successful. We kicked off the event Tuesday evening when (despite some pretty serious snow) a dozen legislators joined us for a reception near the Capitol. Following the reception, we were joined for dinner by Senate Majority Leader Steven Horsford and Nevada Governor Jim Gibbons. The Governor addressed our group, talking primarily about the massive deficit faced by the state and the ways he hopes to make some headway to get the state back on track. He joined us for well over an hour, taking questions and offering his insight into the ways the chapter can become a greater presence in the state, and encouraging us to become a resource for him and the legislature. Wednesday our attending physicians started the day with breakfast and a presentation by Lawrence Matheis, Executive Director of the Nevada State Medical Association (NSMA). Mr. Matheis gave us some great input and statistics to use in our visits, primarily about the background and possible effects Assembly Bill 52, outlined below. After breakfast we headed to the Capitol where we met with more than twenty elected officials including the chairs and vice chairs of the Senate and Assembly Health Committees, Governor Jim Gibbons, Lieutenant Governor Brian Krolicki, Senate President Pro Tem Michael Schneider, and Assembly Speaker Barbara Buckley. We primarily focused on three issues: Tort Reform Between 2000 and 2004 median malpractice damage awards in Nevada increased 27 percent, prompting the legislature to enact a cap of $350,000. Recently, however, a poorly handled hepatitis outbreak in the state has trial lawyers chomping at the bit to carve out exemptions and weaken the law. Mr. Matheis of NSMA told us during breakfast that he expected very onerous legislation to be introduced in the next several days. And, in fact, according to articles in the paper March 24, legislation has been introduced that would remove the $350,000 cap on pain and suffering damages. Click here for article. We urged the legislators to keep the law as is. Several legislators – including Peggy Pierce, Vice Chair of the Assembly Health Committee, who said she would “like to see justice decided in the courts,” but acknowledged that she didn’t see any legislation passing this session. We also received assurances from Governor Gibbons that he would veto any legislation that would weaken the current law. While we remain hopeful that they will remain true to their word, everyone of us still need to remain vigilant and voice our concerns to our legislators. We urge all Nevada cardiology community members to write or call their State House legislators voicing their concerns about this legislation. Go to the "Who's My Legislator" section of this website for your representatives in the State House and Senate. Assembly Bill 52 A.B. 52 would require that a hospital located in a county with a population of more than 400,000 (currently only Clark County, i.e., Las Vegas) provide emergency care to a patient if that hospital has on its staff a specialist in the necessary type of care, or to enter into an agreement with another hospital to provide the service not offered by the hospital. The hospital must comply with this law regardless of the patient’s financial status. The bill is being pushed by the University Health System of Las Vegas, but is opposed by NSMA. While the chapter agrees with the concept – the practice of “dumping” indigent patients at other facilities is deplorable - the chapter is opposing this bill in its current form. We argued that the law should apply to the whole state, and that it's clear that the bill is less an attempt at providing quality care for all patients and more an attempt to allow for-profit hospitals to be allowed to dump patients into county hospitals. Several legislators were very familiar with the bill -Senator Joyce Woodhouse (D-Henderson) had had several conversations with her Chamber of Commerce about their dislike of the bill. In fact, even Clark County legislators weren't enamored of the idea of promoting the “dumping” of patients. Assembly Health Committee Vice Chair Peggy Pierce (D-Las Vegas) urged us to testify should the bill have a hearing, and Senator Woodhouse (Vice Chair of the Senate Health Committee) told us that should it come to the Senate she will staunchly oppose it. We will be keeping our eyes open for movement on the bill. Tobacco Excise Tax The current cigarette excise tax in Nevada is only 80 cents a pack, while the current national average is $1.21. We told legislators that since we currently cannot prevent smoking with enhanced smoke free air laws (a voter referendum prohibits strengthening smoke free laws until 2011) the state can attempt to prevent smoking AND decrease the deficit through an increased cigarette tax. Not surprisingly, reactions were mixed. Also not surprisingly, reactions were not split along party lines, but between legislators who have casinos in their district and those without. Tobacco issues in Nevada get considerably more complicated than in other states because of what can and cannot be considered a casino. For example, several years ago a chain of grocery stores put in 100 slot machines so they could be classified as a casino and thus smoking was allowed in the slot machine section of the store. As a result of these complications, even those that were supportive of an increased tobacco tax were not confident it could pass. However, we presented a compelling argument of how successful such increases have been in other states - for example, North Carolina increased their cigarette tax by 25 cents per pack, leading to an 18.9 percent decrease in cigarette sales and yielded a revenue increase of nearly $160 million. We also argued that increasing the tax will prevent kids from smoking, citing a Campaign for Tobacco Free Kids estimate that every 10 percent increase in the real price of cigarettes reduces the number of kids who smoke by six or seven percent. We got assurances from several Health Committee legislators that such an increase could be introduced if not passed in this session, but would almost certainly be passed in the next session if the deficit continues. Finally, it was not all work and no play – during the Assembly session, our attending physicians were invited to sit with their Assembly Members on the Assembly floor for the entire session, and near the conclusion of the session were individually introduced and asked to stand and given a round of applause, a fitting tribute to their hard work. Sincerely, Bill William Graettinger, M.D., F.A.C.C. President Nevada Chapter, American College of Cardiology