Last summer they were just ideas.
But many of the proposed bill drafts considered six months ago by Nevada legislators and health officials aimed at preventing a disease outbreak similar to the one documented at a Las Vegas endoscopy center last January are starting to take shape.
"A lot of lessons were learned out of the hepatitis C and the ambulatory surgery center crisis from a facility standpoint," Richard Whitley, administrator of the Nevada State Health Division, said during a budget legislative hearing this week.
Whitley said the lessons have led to a holistic view of the state's health care system.
"What we've found is that many people viewed the Bureau of Licensure and Certification as being the connector to a truly fragmented system," he said of the agency now known as the Bureau of Health Care Quality and Compliance, which licenses ambulatory surgery centers and hospitals.
"As an agency, we weren't filling that role. There were breakdowns in communication across other licensing and accrediting bodies."
Most of the legislative bills that center around the hepatitis C outbreak and are headed for the Legislature on Monday look to bridge potential gaps in communication during a public health crisis.
Also up for consideration are measures that strengthen health authorities' power during disease investigations, call for better oversight of ambulatory surgery centers and change the way in which health professionals are appointed to regulatory boards.
Some, such as Assembly Bill 123 and Senate Bill 70, are aimed at monitoring the use of anesthesia and sedation, drugs linked to the transmission of hepatitis C to eight patients at the Endoscopy Center of Southern Nevada.
Another bill, Assembly Bill 112, gives the governor authority to declare a public health emergency immediately after learning of a public health threat. That bill also creates the Committee on Public Health Emergencies, which would establish provisions for responding to, and resolving, public health emergencies.
The Southern Nevada Health District announced in late February that a half-dozen people had contracted hepatitis C at the Endoscopy Center's Shadow Lane clinic because of breaches in infection control. Much of the ensuing community outrage stemmed from the fact that the physicians involved continued to practice and the facility remained open.
Under existing law, a licensing agency can summarily suspend a license if it finds that a threat to the public's health, safety or welfare warrants emergency action.
Senate Bill 76, which seeks to revise the law, clarifies when a license could be suspended and by whom.
The bill would extend suspending power to the chief of the licensing agency, a member of the licensing agency's governing body or an office, or an employee of the licensing agency.
Another issue raised after the outbreak dealt with the inspections of ambulatory surgery centers.
Federal requirements set by the U.S. Department of Medicare and Medicaid Services recommend that inspections occur every six years. Nevada lists a three-year inspection rule for ambulatory surgery centers.
Because an outside body accredited the Shadow Lane facility, that organization was responsible for inspecting the facility. But it was learned later that the Shadow Lane facility had lost its accreditation and that the state's licensing bureau had not been notified.
Senate Bill 70 and Assembly Bill 123 call for annual inspections of ambulatory surgery centers and certain physician offices where surgical procedures require conscious, general and deep levels of sedation.
Ambulatory surgery centers and some physician offices would have to obtain a permit before they could provide anesthesia and sedation drugs.
AB123 goes a step further in requiring national accreditation of Nevada's ambulatory surgery centers.
Assembly Bill 8, introduced by the Committee on Commerce and Labor, would make changes to the process of appointments to Nevada State Board of Medical Examiners, the Nevada State Board of Osteopathic Medicine and the Nevada State Board of Homeopathic Medicine. That bill also requires the boards to keep copies of conflict-of-interest policies, which most regulatory boards already require.
Another issue raised during the investigation of the hepatitis C outbreak was why nurse anesthetists did not alert health authorities sooner about unsafe practices.
Debra Scott, executive director of the Nevada State Board of Nursing, said some nurses were afraid to step forward out of fear they would lose their jobs.
Assembly Bill 10 would prohibit retaliation or discrimination against registered nurses, licensed practical nurses and nursing assistants who report certain information relating to patient safety.
Scott said the bill, if it passes, "really does have some teeth."
"This bill presumes that whenever action has been taken against an employee that has spoken up, it was taken as a result of retaliation," she said.
Contact reporter Annette Wells at firstname.lastname@example.org or 702-383-0283.