Electronically Filed

10/26/2017 8:12 AM
Steven D. Grierson
CLERK OF THE COURT
A-17-763723-W
CASE NO. ___________________

Department 27
DEPT. NO. __________________

EIGHTH JUDICIAL DISTRICT COURT

STATE OF NEVADA

JANE DOE, an individual,

on behalf of herself and similarly situated patients,

Petitioner,
v.

UNIVERSITY OF NEVADA, LAS VEGAS, a Nevada Public

Entity / Institution; SHAWN GERSTENBERGER, in his official capacity
as Dean of the UNLV School of Community Health Services and the Dean
of the University of Medicine,

Respondent,

EMERGENCY PETITION FOR

WRIT OF MANDAMUS

HAFTERLAW
JACOB L. HAFTER, Esq.
Nevada Bar Number 9303
6851 W. Charleston Boulevard
Las Vegas, Nevada 89117
jhafter@hafterlaw.com

October 26, 2017

Case Number: A-17-763723-W

 EMERGENCY PETITION FOR WRIT OF MANDAMUS

Petitioner, JANE DOE, seeks a writ of mandamus ordering the

UNIVERSITY OF NEVADA, LAS VEGAS, a Nevada Public Entity /

Institution, and SHAWN GERSTENBERGER, in his official capacity as

Dean of the UNLV School of Community Health Services and the Dean of

the University of Medicine (collectively, UNLV) to immediately reinstate

the Nevada Care Program (NCP), as set forth in the grant which was

awarded pursuant to the Ryan White HIV/AIDS Program, as administered by

the U.S. Department of Health and Human Services, Health Resources and

Services Administration (HRSA). The NCP provides outpatient HIV

primary care services targeted to low income, vulnerable, medically

underserved women, infants, children, and youth living with HIV for the

following service areas: AZ county Mojave NV counties Clark, Nye.

Currently, there are no other pediatric providers in Clark County, Nevada,

who are trained and experienced to provide these services. NCP services

approximately 100 patients on an on-going basis, and also provides support

services to 10 labor and delivery centers throughout the service area.

Petitioner is a four year old female who is HIV positive, who has been

receiving care for her HIV status with the NCP since birth. On or about

September 15, 2017, UNLV directed Echezona Ezeanolue, MD, director of

ii
the NCP, and Dina Patel, NP, program coordinator, to immediately stop

seeing patients. As a result, JANE DOE, and those similarly situated, have

not been able to obtain the specialized care that she needs to address her HIV

positive status.

DATED this 26th day of October, 2017.

HAFTERLAW

By: _______________________________
JACOB L. HAFTER, ESQ.
Nevada Bar Number 9303
6851 Charleston Boulevard
Las Vegas, Nevada 89117
jhafter@hafterlaw.com
Counsel for Petitioner

iii
 VERIFICATION

Under penalties of perjury, the undersigned declares that he is counsel

for the petitioner named in the foregoing petition and knows the contents

thereof; that the pleading is true of his own knowledge, except as to those

matters stated on information and belief, and that as to such matters he

believes them to be true.

This verification is made pursuant to NRS 15.010.

DATED this 26th day of October, 2017.

HAFTERLAW

By: _______________________________
JACOB L. HAFTER, ESQ.
Nevada Bar Number 9303
6851 Charleston Boulevard
Las Vegas, Nevada 89117
jhafter@hafterlaw.com
Counsel for Petitioner

iv
 TABLE OF CONTENTS

EMERGENCY PETITION FOR WRIT OF MANDAMUS ......................... ii

VERIFICATION ........................................................................................... iv

MEMORANDUM OF POINTS AND AUTHORITIES.................................1

ISSUES PRESENTED ....................................................................................4

WRITS OF MANDAMUS ARE APPROPRIATE IN THIS CASE ..............4

BACKGROUND .............................................................................................5

HRSAs Ryan White HIV / AIDS Program............................................ 5

The Nevada Care Program ................................................................... 7

NCP and UNLV .....................................................................................9

Petitioner & the NCP ..........................................................................10

ARGUMENT .................................................................................................12

A. UNLV APPLIED FOR THE GRANT AND HAS AN

OBLIGATION TO CONTINUE TO OPERATE THE NCP
PROGRAM .....................................................................................12

B. UNLV MANIFESTLY ABUSED ITS DISCRETION WHEN

CLOSING THE PROGRAM ..........................................................14

C. THE TERMINATION OF THE NCP PROGRAM VIOLATES

PETITIONERS CONSTITUTIONAL DUE PROCESS RIGHTS
.........................................................................................................16

D. PETITIONER SHOULD BE AWARDED ATTORNEYS FEES

AND COSTS FOR BRINGING THIS PETITION ........................20

E. AS TIME IS OF THE ESSENCE, THIS COURT SHOULD

EXPEDITE THE REVIEW OF THIS PETITION .........................28

CONCLUSION..............................................................................................29

i
 TABLE OF AUTHORITIES

CASES

Albios v. Horizon Communities, Inc., 122 Nev. 409, 417, 132 P.3d 1022, 1028

(2006) ........................................................................................... 20, 25

Alyeska Pipeline Serv. Co. v. The Wilderness Socy, 421 U.S. 240, 257

(1975) ..................................................................................... 22, 23, 24

Arnold v. Ariz. Dept. of Health Servs., 160 Ariz. 593, 609, 775 P.2d 521, 537

(1989) ..................................................................................................26

Board of Regents of State Colleges v. Roth, 408 U.S. 564, 577 (1972) .......17

Buckhannon Bd. & Care Home, Inc. v. W. Va. Dept of Health & Human

Res., 532 U.S. 598, 602-03 (2001) ......................................................22

Business Computer Rentals v. State Treas., 114 Nev. 63, 67, 953 P.2d 13, 15

(1998) ....................................................................................................5

Carrier v. Salt Lake County, 2004 UT 98, 104 P.3d 1208 (Utah, 2004).......26

City of Las Vegas v. Cragin Industries, 86 Nev. 933, 940, 478 P.2d 585, 590

(1970) ..................................................................................................21

Cruzan v. Dir. Mo. Dep't of Health, 497 U.S. 261, 278 (1990) ....................17

Erickson v. U.S. ex rel. Dept. of Health and Human Services, 67 F.3d 858 (9th

Cir., 1995)............................................................................................17
ii
Fox Valley Families Against Planned Parentood v. Planned Parenthood of Ill.,

, LLC, 2015 IL App (2d) 131019 (Ill. App., 2015).............................25

Gold Coast Neighborhood Assn v. State, No. CAAP-14-0000472 (Haw.

App., 2015) ..........................................................................................25

Gragson v. Toco, 90 Nev. 131, 133, 520 P.2d 616, 617 (1974)......................5

Horgan v. Felton, 123 Nev. 577, 579, 170 P.3d 982, 983 (2007) .......... 20, 25

International Game Tech. v. Dist. Ct., 124 Nev. 193, 197, 179 P.3d 556, 558

(2008) ..................................................................................................14

Int'l Game Tech., Inc. v. Second Judicial Dist. Court, 124 Nev. 193, 197, 179

P.3d 556, 558 (2008) .............................................................................4

Key Bank v. Donnels, 106 Nev. 49, 53, 787 P.2d 382, 385 (1990) ..............21

Maria P. v. Riles, 43 Cal.3d 1281, 240 Cal.Rptr. 872 (Cal., 1987) ..............26

McCracken v. Cory, 99 Nev. 471, 473, 664 P.2d 349, 350 (1983)...............21

Mineral County v. State, Dep't of Conserv., 117 Nev. 235, 243, 20 P.3d 800,

805 (2001) .............................................................................................5

Parham v. J.R., 442 U.S. 584, 600 (1979) .....................................................17

Pepperwood Homeowners Assn v. Mitchell, 2015 UT App 137 (Utah App.,

2015) ....................................................................................................25

Perry v. Sindermann, 408 U.S. 593, 601, 92 S.Ct. 2694 (1972) ...................19

Press v. Lucky Stores, Inc. 34 Cal.3d 311, 317-318 (Ca.Sup.Ct.1983) ........27

iii
Round Hill Gen. Improvement Dist. v. Newman, 97 Nev. 601, 60304, 637

P.2d 534, 536 (1981) .......................................................................4, 14

Roybal v. Governing Bd. of Salinas City Elem. School Dist. 159 Cal.App.4th

1143, 1147(Ca.Ct.App.2008) ..............................................................27

Runnels v. Rosendale, 499 F.2d 733, 735 (9th Cir. 1974) ............................17

Rust v. Sullivan, 500 U.S. 173, 111 S.Ct. 1759, 114 L.Ed.2d 233 (1991) ...19

Sandy Valley Assocs. v. Sky Ranch Estates, 117 Nev. 948, 35 P.3d 964 (2001)

.............................................................................................................21

Schroeder v. McDonald, 55 F.3d 454, 462 (9th Cir.1995)............................16

Society Created to Reduce Urban Blight (SCRUB) v. Zoning Board of

Adjustment of the City of Philadelphia, 729 A.2d 117, 121 n.13 (Pa.

Cmwlth. 1999) .....................................................................................26

State v. Eighth Judicial Dist. Court (Armstrong), 127 Nev. 927, 93132, 267

P.3d 777, 780 (2011) .............................................................................4

Stretten v. Wadsworth Veterans Hosp., 537 F.2d 361, 366-67 (9th Cir. 1976)

.............................................................................................................17

Tarkanian v. Nat'l Collegiate Athletic Ass'n, 103 Nev. 331, 337, 741 P.2d

1345, 1349 (1987), rev'd on other grounds, 488 U.S. 179, 109 S.Ct.

454, 102 L.Ed.2d 469 (1988) ..............................................................16

Vitekv. Jones, 445 U.S. 480, 494 (1980).......................................................17

iv
Woodland Hills Residents Assn., Inc. v. City Council, 23 Cal.3d 917, 933,

154 Cal.Rptr. 503, 593 P.2d 200. (Cal.Sup.Ct.1979)..........................26

Woods v. Label Investment Corp., 107 Nev. 419, 427, 812 P.2d 1293, 1299

(1991) ..................................................................................................21

STATUTES

42 U.S.C. 1988............................................................................................23

42 U.S.C. 1988.............................................................................................22

California Code of Civil Procedure 1021.5 ................................................27

Minn. Stat. 8.31, subd. 3a (2014) ...............................................................25

NRS 15.010.................................................................................................. iv

NRS 18.010(2)(a) ........................................................................................21

NRS 34.160..............................................................................................4, 14

NRS 633.511(1)(n) ........................................................................................1

OTHER AUTHORITIES

Open Government Act of 2007, Pub. L. No. 110-175, 121 Stat. 2524 (codified

at 5 U.S.C. 552(a)(4)(E) (2009) .......................................................22

Ryan White Comprehensive AIDS Resources Emergency (CARE) Act.,

Pub.L. 101381, 104 Stat. 576 ..............................................................6

v
CONSTITUTIONAL PROVISIONS

Art. III Sec. 1 of US. Constitution .................................................................24

Art. VI, Sec 1 of the Nevada Constitution.....................................................24

Nev. Const. art. 1, 8, cl. 5 ...........................................................................16

U.S. Const. amend. XIV ................................................................................16

TREATISES

Black's Law Dictionary (9th ed.2009) .............................................................5

vi
 MEMORANDUM OF POINTS AND AUTHORITIES

As reported this week by the Las Vegas Review Journal, [f]ive weeks

ago, UNLV suspended a maternal-HIV program without warning the medical

personnel who run the program, or their patients. UNLV clinics closure

leaves patients scrambling for options, Las Vegas Review Journal, (October

20, 2017) (https://www.reviewjournal.com/news/education/unlv-clinics-

closure-leaves-patients-scrambling-for-options). They did this without any

notice to the 65+ patients who currently receive ongoing HIV medical services

from the program, despite a state law that requires that patients be given notice

of any medical office closing, 1 and without concern that the program is the

only facility in the southern Nevada region that has providers who are

educated and experienced in pediatric HIV care and who are dedicated around

the clock to the provision of that care.

1
The ability for UNLV to demand that the NCP program immediately stops
seeing patients is extremely concerning because it interferes with the professional
obligations of the health care providers for the NCP program. For example, NRS
633.511(1)(n) states that [t]erminating the medical care of a patient without adequate
notice or without making other arrangements for the continued care of the patient, is a
ground for initiating disciplinary action against an osteopathic medical physician. Because
the NCP providers were locked out of the program, they are not capable to make such
arrangements for the 65+ patients receiving routine care from the NCP program. Petitioner,
as a patient of the NCP program, never received any notice that program was closed. She
discovered this when she tried to contact the NCP program to obtain services. This is very
concerning.

1
 Petitioner, a four (4) year old female with a complex case of HIV that

is resistant to most HIV treatments, is one of the 65+ patients that no longer

have any competent and available resource to obtain her medical care from,

now that the program has closed. Petitioner, and those similarly situated to

her, have no place to go and have no access to the expertise necessary to

manage their disease. As such, they cannot obtain refills on their HIV specific

medications, as their primary care physicians are not competent nor

comfortable with prescribing this complex medical regimens. Currently,

Petitioner is in a grave situation of running out of her life saving medications.

However, the program provides more than just access to drugs; it provides

complete care in a full, uninterrupted and undivided attention of a physician

and nurse practitioner that have extensive training and experience managing

the complex health care needs of HIV patients. It is this care, attention to

detail and unfettered access to her tailored health care management that the

Petitioner, and those 65+ similarly situated patients no longer have.

Worse, the program, known as the Nevada Care Program, is

completely funded by a federal grant from the U.S. Department of Health and

Human Services, Health Resources and Services Administration (HRSA);

it costs UNLV nothing to operate. UNLV courted the NCP from UNR in

2015. Beginning in 2016, the HRSA grant that completely funds the NCP

2
was transferred from UNR to UNLV, upon the application of UNLV. That

request was renewed in 2017, a request that was granted in late July, 2017.

Notwithstanding, UNLV arbitrarily and capriciously ordered that Dr.

Ezeanolue, an award winning physician dedicated to underserved medical

populations, and his staff, immediately stop seeing NCPs patients,

irrespective of his moral and legal obligations to his patients.

Without knowing where else to turn to access to the vital care necessary

to keep her HIV disease under control, and without any other options to obtain

that care, Petitioner, on behalf of herself and similarly situated patients, turns

to this Court and seeks a writ of mandamus from this Court ordering UNLV

to resume the NCP program, as it said it was going to do in its 2017 application

for the renewal of the HRSA grant, and which it agreed to do upon receiving

notice of the grant award. Needless to say, time is of the essence, as, without

access to the NCP program, Petitioner cannot get her HIV drugs that she so

desperately needs. Petitioner asks this Court to consider this writ petition on

an emergency basis. Petitioner also asks this Court to award Petitioner the

fees and costs associated with bringing this writ petition.

3
 ISSUES PRESENTED

Can UNLV summarily stop operating a program that is 100% funded

by a grant a grant is requested to receive provided by U.S. Department of

Health and Human Services, Health Resources and Services Administration

(HRSA)?

WRITS OF MANDAMUS ARE APPROPRIATE IN THIS CASE

District courts have the power to issue writs of Mandamus. Nev.

Const. art. 6, 6(1). A writ of mandamus is available to compel the

performance of an act that the law requires ... or to control an arbitrary or

capricious exercise of discretion. Int'l Game Tech., Inc. v. Second Judicial

Dist. Court, 124 Nev. 193, 197, 179 P.3d 556, 558 (2008); see NRS 34.160.

Mandamus will not lie to control discretionary action, unless discretion is

manifestly abused or is exercised arbitrarily or capriciously. Round Hill Gen.

Improvement Dist. v. Newman, 97 Nev. 601, 60304, 637 P.2d 534, 536

(1981) (citation omitted). An exercise of discretion is considered arbitrary if

it is founded on prejudice or preference rather than on reason and capricious

if it is contrary to the evidence or established rules of law. State v. Eighth

Judicial Dist. Court (Armstrong), 127 Nev. 927, 93132, 267 P.3d 777, 780

(2011) (quoting Arbitrary and Capricious, Black's Law Dictionary (9th

4
ed.2009)). The burden of proof to show the capriciousness is on the

applicant. Gragson v. Toco, 90 Nev. 131, 133, 520 P.2d 616, 617 (1974). A

writ may issue, however, where an important issue of law needs clarification

and public policy is served by this court's invocation of its original

jurisdiction. Mineral County v. State, Dep't of Conserv., 117 Nev. 235, 243,

20 P.3d 800, 805 (2001) (quoting Business Computer Rentals v. State Treas.,

114 Nev. 63, 67, 953 P.2d 13, 15 (1998)).

BACKGROUND

HRSAs Ryan White HIV / AIDS Program

The Ryan White HIV/AIDS Program is the largest federal program

focused specifically on providing HIV care and treatment services to people

living with HIV. Working with cities, states, and local community-based

organizations, the Program, as administered by HRSA, provides a

comprehensive system of care for people living with HIV who are uninsured

or underinsured. A smaller but critical portion of the Program is used to fund

technical assistance, clinical training, and the development of innovative

models of care.

The legislation creating this program was first enacted in 1990 as the

Ryan White Comprehensive AIDS Resources Emergency (CARE) Act. See

5
Pub.L. 101381, 104 Stat. 576 (enacted August 18, 1990). It has been

amended and reauthorized four times in 1996, 2000, 2006, and 2009. The

Ryan White HIV/AIDS Program legislation has been amended with each

reauthorization to accommodate new and emerging needs, such as an

increased emphasis on funding core medical services and changes in funding

formulas. The Ryan White HIV/AIDS Program provides a comprehensive

system of care that includes primary medical care and essential support

services for people living with HIV who are uninsured or underinsured. The

Program works with cities, states, and local community-based organizations

to provide HIV care and treatment services to more than half a million people

each year. The Program reaches approximately 52% of all people diagnosed

with HIV in the United States.

The majority of Ryan White HIV/AIDS Program funds support primary

medical care and essential support services. A smaller but equally critical

portion is used to fund technical assistance, clinical training, and the

development of innovative models of care. The Program serves as an

important source of ongoing access to HIV medication that can enable people

living with HIV to live close to normal lifespans.

6
The Nevada Care Program
The Nevada Care Program (NCP) was started approximately 10 years

ago in response to the segmented and incomplete approach to HIV

management, treatment, education and prevention in the southern Nevada

region. Initially developed in response to six reported cases of perinatal HIV

infections through mother-to-child transmission during a six-month period in

2006, the NCP was initially housed at the University of Nevada, Reno, School

of Medicine, and implemented with support from the American Academy of

Pediatrics and a private Las Vegas philanthropist. The NCP was first awarded

grant funding under Part D of HRSAs Ryan White HIV/AIDS Program in

2012. In 2015, NCP moved from UNR to UNLVs School of Community

Health Science.

NCP is only center in the southern Nevada region that provides

coordinated and integrated care for women, infants, children and youth

(collectively, the WICY population) infected or affected by HIV/AIDS.

This community-based program, at the University of Nevada, Las Vegas

(UNLV) has a network of obstetricians, gynecologists, primary care and

pediatric providers that work collaboratively with the Southern Nevada Health

District (SNHD), all area hospitals and area pharmacy service providers to

ensure that the WICY population receive effective and efficient care.

7
 The NCP was started by Echezona Ezeanolue, M.D., a Professor of

Pediatrics and Public Health. Dr. Ezeanolue is board certified in Pediatrics

and Infectious Disease with extensive experience and expertise in caring for

infants, children and youth infected/affected by HIV/AIDS. Dr. Ezeanolue

still oversees the NCP. He is currently the PI on multiple NIH funded projects.

One of the NIH funded programs, the Healthy Beginning Initiatives,

developed and implemented an innovative intervention to increase HIV

testing among pregnant women and their male partners in resource-limited

settings. Adolescent Coordinated Transition (ACT), is a second NIH-funded

grant that focuses on transitioning adolescents with HIV/AIDS from pediatric

care to adult care. Intervention for sustainable testing and retention (iSTAR)

is the third NIH-funded grant that focuses on increasing the rate of retention

and viral load suppression among HIV pregnant women and children in

Nigeria

At that time the NCP was created, Nevada was the only state west of

the Mississippi with an elevated number of HIV+ women of childbearing age.

Since 2007, the NCP has developed and implemented appropriate protocols

for the management of pregnant women presenting in labor with known and

unknown HIV sero-status in 12 local hospitals. The NCP program provides

follow up and management of HIV-exposed infants and management of HIV-

8
infected children and youth in the community. As a result of this integrated,

patient-centered and coordinated approach, prenatal care among HIV-infected

pregnant women has increased; loss to follow up among HIV-exposed infants

decreased; and the quality of care received by HIV-infected children has

improved. This effective use of the principles of implementation science to

improve health services led to better health outcomes; only two new cases of

pediatric HIV infection in Southern Nevada has been documented since 2007.

NCP and UNLV

On July 26, 2017, HRSA issued a Notice of Award Authorization to the

University of Nevada, Las Vegas, to fund the NCP through July 31, 2018. See

Exhibit A. Dr. Ezeanolue is listed as the Program Director / Principal

Investigator for the NCP. Id. The award is subject to 45 CFR 75, Uniform

Administrative Requirements, Cost Principles, and Audit Requirements for

HHS Awards. The award was pursuant to the funding request which was

submitted by the NCP and approved. The funds must be spent in accordance

with the request and the Notice of Award Authorization. Upon information

and belief, the HRSA grant covers 100% of the NCP program costs.

Upon information and belief, the funding goes directly to UNLV who

then administers the reimbursement of NCP program costs; neither Dr.

9
Ezeanolue, nor Dina Patel, have any control or oversight of financial

expenditures.

Upon information and belief, on or about September 15, 2017,

UNLV directed Echezona Ezeanolue, MD, director of the NCP, and Dina

Patel, NP, program coordinator, collectively, the entire staff of the NCP, to

immediately stop seeing patients.

Petitioner & the NCP

Petitioner is a four (4) year old female who was born HIV positive. She

has been enrolled in the NCP since birth. As an enrolled patient, Petitioner,

and many other patients who are similarly situated to her, is followed at the

NCP Pediatric Clinic. Through the clinic, Petitioner is monitored for any

complications of her exposure or effects of the antiretroviral medication.

Because of her viral load/the severity of her HIV infection, Petitioner

became resistant to many medications that are usually used to treat HIV

positive patients. Currently, only one medication is effective, however, that

medication is difficult to administer, requiring a gastrointestinal feeding tube

to ensure proper medication administration and maintenance. Unfortunately,

this treatment has resulted in numerous adverse effects, including a hernia and

a recent gastrointestinal bleed.

10
 The NCP is the only health care provider in the area that has the

expertise and personnel to manage the complex medical needs of Petitioner,

as a pediatric HIV patient. At the time the NCP was closed, Petitioner was

hospitalized in the ICU for the recent gastrointestinal bleed and was not aware

of the programs closure. Petitioner was never sent any letters or provided

any referrals for alternative care. Petitioner was released from the hospital a

week later. Upon discharged, Petitioners mother called the NCP to arrange

a follow up appointment and continue with the complex task of Petitioners

HIV management; Petitioners mother was told that the NCP office was

closed and to follow up with her primary care physician. Petitioners mother

contacted the primary care physician, however, because she is not experienced

or qualified to manage complex HIV care, she referred Petitioner back to the

NCP.

At the current time, Petitioner is unable to obtain the requisite

monitoring and prescription refills necessary to keep her HIV infection under

control. For example, the day before filing this writ petition, Petitioner was

unable to reach any pediatric HIV providers in the southern Nevada area,

despite having an urgent health care need. As of the date of the filing of this

writ petition, Petitioner is unable to obtain the specific treatment necessary for

her current health crisis. There is significant concern and belief that without

11
access to the specialized care and expertise of the NCP personnel, her HIV

will not be controllable.

ARGUMENT

A. UNLV APPLIED FOR THE GRANT AND HAS AN

OBLIGATION TO CONTINUE TO OPERATE THE NCP
PROGRAM

HRSA has been funding the NCP program since 2012. Beginning in

2015, UNLV recruited the NCP program to transfer from UNR to UNLV. In

2017, UNLV reapplied for the continued funding from HRSA for the NCP

program. As a result of the request, HRSA approved the grant and continued

the funding for this program.

As set forth in the Notice of Award Authorization, UNLV must

comply with all terms and conditions outlined in their grant award, including

grant policy terms and conditions outlined in applicable Department of Health

and Human Services (HHS) Grants Policy Statements, and requirements

imposed by program statutes and regulations and HHS grant administration

regulations, as applicable as well as any requirements or limitations in any

applicable appropriations acts. Exhibit A. Included within those terms is

the requirement to use the grant funds for the purposes in the Notice of Award

12
Authorization and the grant proposal upon which the Notice of Award

Authorization was based.

As set forth in the Notice of Award Authorization, the Ryan White

HIV/AIDS Program legislation specifies criteria for the expenditure of Part D

grant funds. Id. Funds are to be used to provide family centered care in the

outpatient or ambulatory care setting to low income, uninsured, and medically

underserved women (25 years and older) living with HIV, infants (up to two

years of age) exposed to or living with HIV, children (ages two to 12) living

with HIV, and youth (ages 13 to 24) living with HIV. Id. No more than 10

percent of the funds awarded may be spent on administrative costs applicable

direct costs and all indirect costs count toward this 10 percent limit. Id.

While Petitioner, a four (4) year old patient, does not have access to all

of the paperwork that relates to the grant, it is inconceivable that included

within the paperwork that supports the grant application, the award of the

grant and the grant terms and conditions, is the ability for UNLV to simply

walk away from the program without any rational explanation. UNLV asked

for the NCP program, embraced the NCP program, and has taken active steps

to obtain federal funding for the on-going operations of the NCP program.

///

///

13
B. UNLV MANIFESTLY ABUSED ITS DISCRETION WHEN
CLOSING THE PROGRAM

As discussed above, [a] writ of mandamus is available to compel the

performance of an act that the law requires as a duty resulting from an office,

trust, or station or to control an arbitrary or capricious exercise of discretion.

International Game Tech. v. Dist. Ct., 124 Nev. 193, 197, 179 P.3d 556, 558

(2008); see also NRS 34.160. Mandamus will not lie to control [a]

discretionary action, unless discretion is manifestly abused or is exercised

arbitrarily or capriciously, Round Hill Gen. Imp. Dist. v. Newman, 97 Nev.

601, 60304, 637 P.2d 534, 536 (1981) (internal citation omitted).

In this case, UNLV has manifestly abused its discretion in running the

NCP program. There is no rational basis for why the NCP program has been

shuttered. Upon information and belief, Dr. Ezeanolue, and his nurse

practitioner, Dina Patel, are willing and able to continue to provide the care

that they have been providing to our community for years. As the NCP

program is completely funded by the HRSA grant, there is no financial

justification for the closure. Moreover, as recent as September 19, 2107, Dean

Shawn Gerstenberger, PhD, told Ms. Patel that the clinic operated by the NCP

program was being operated in a good way and that he had not heard

14
anything bad about the clinic in any way shape or form, that he had heard

good things about [Ms. Patel and] good things about the patient care.

Upon information and belief, the Dean who made the decision to shutter

the program has made discriminatory comments towards the NCP programs

director, Dr. Ezeanolue. Specifically, Shawn Gerstenberger, PhD, has made

comments on two separate occasions to Dr. Ezeanolue, a physician of

Nigerian origin, that all Nigerians cannot be trusted, that Nigeria is filled

with crooks, and that all Nigerians are criminals. It is believed that Dean

Gerstenbergers actions with respect to the NCP Program are nothing more

than a personal vendetta to get rid of Dr. Ezeanolue because of Dean

Gerstenbergers personal prejudices and biases, and Dr. Ezeanolues reporting

of these inappropriate comments to the human resources and compliance

departments of UNLV. 2 To that end, upon information and belief, Dina Patel,

program coordinator and nurse practitioner for the NCP program, was told by

other administrators at UNLV that she should jump ship and save herself

from being associated with Dr. Ezeanolue. Due to the urgent nature of this

writ petition, Petitioner was unable to provide an affidavit supporting these

2
Despite the fact that these two cases have been well documented by Dr.
Ezeanolue with the human resources and compliance departments, nothing has been done
by UNLV to address this behavior. Dr. Ezeanolue is now pursuing a claim of
discrimination and retaliation with the Nevada Equal Rights Commission.

15
claims along with this writ petition, however, based on discussions with Dr.

Ezeanolue and Ms. Patel, these claims which are made in this paragraph can

be justified through an evidentiary hearing. Petitioner will also work

diligently to obtain sworn statements to support these claims, statements that

will be filed in a supplement to this writ petition as soon as possible.

C. THE TERMINATION OF THE NCP PROGRAM VIOLATES

PETITIONERS CONSTITUTIONAL DUE PROCESS RIGHTS

The Due Process Clause of the Fourteenth Amendment protects

individuals from arbitrary government action by prohibiting states from

depriving people of life, liberty, or property without due process of law.

U.S. Const. amend. XIV. The protections of due process only attach when

there is a deprivation of a protected property or liberty interest. Nev. Const.

art. 1, 8, cl. 5; see also Tarkanian v. Nat'l Collegiate Athletic Ass'n, 103

Nev. 331, 337, 741 P.2d 1345, 1349 (1987), rev'd on other grounds, 488 U.S.

179, 109 S.Ct. 454, 102 L.Ed.2d 469 (1988). The threshold question in any

due process challenge is whether a protected property or liberty interest

actually exists. See American Mfrs. Mut. Ins. Co. v. Sullivan, 526 U.S. 40,

59 (1999); Schroeder v. McDonald, 55 F.3d 454, 462 (9th Cir.1995). To have

a protectable property interest in a benefit such as a grant, a person must have

16
more than a unilateral expectation of [the claimed interest]. He must, instead,

have a legitimate claim of entitlement to it. Board of Regents of State

Colleges v. Roth, 408 U.S. 564, 577 (1972). A legitimate claim of entitlement

may arise from a contract, a statute, or a regulation, provided the source of the

claim is specific enough to require the provision of the benefit on a

nondiscretionary basis. See Stretten v. Wadsworth Veterans Hosp., 537 F.2d

361, 366-67 (9th Cir. 1976).

There is no case law that discusses whether a patient has a property or

liberty interest in a health care program. That is not to say that health care

programs have not been the source of such rights. For example, there is case

law that says that a physician or other medical provider has a protected liberty

interest in participating in Medicare. See Erickson v. U.S. ex rel. Dept. of

Health and Human Services, 67 F.3d 858 (9th Cir. 1995). The Supreme Court

of the United States has recognized a general liberty interest in refusing

medical treatment. Cruzan v. Dir. Mo. Dep't of Health, 497 U.S. 261, 278

(1990); Vitekv. Jones, 445 U.S. 480, 494 (1980); Parham v. J.R., 442 U.S.

584, 600 (1979). The Ninth Circuit has held that this liberty interest includes

the right to refuse surgery. See, e.g., Runnels v. Rosendale, 499 F.2d 733, 735

(9th Cir. 1974).

17
 In this case, Petitioner, and those situated in a similar position to her,

have a legitimate claim of entitlement based on the existence of the NCP

Program, UNLVs application to renew the HRSA grant to completely fund

the program and HRSAs awarding of that grant for the upcoming year. To

that end, it is important to recognize that the NCP program was developed to

address an unserved medical need in the southern Nevada community a need

that is had by Petitioner and those similarly situated to her. In 2006, the year

prior to the NCP program being initiated, the availability of competent

maternal fetal HIV services was so poor that there were five documented cases

of pediatric HIV infection through mother-to-child transmission. By way of

background, according to the National Institute of Health, if a pregnant

women has the proper pre-natal and post-natal care, the risk of transmitting

HIV from mother to child can be lowered to 1% or less. See Preventing

Mother-to-Child Transmission of HIV, HIV Prevention Fact Sheets,

https://aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/20/50/preventing-

mother-to-child-transmission-of-hiv (visited October 25, 2017).

From 2007 to 2012, once the NCP Program began and started providing

proper HIV maternal care services, in addition to community education and

provider training, there were no cases of pediatric HIV infection from mother-

to-child transmission in southern Nevada. There was one incident of mother-

18
to-child transmission of HIV in 2013 in southern Nevada, one in 2015 and one

in 2017, however, those cases all involved mothers who were not able to

access NCP program services. To go from five cases of transmission in one

year to three cases of transmission in 10 years is an amazing contribution to

southern Nevadas public health. It was because of this amazing impact on

this public health issue that the NCP program was first awarded its federal

funds in 2012. In context of such, clearly, the NCP program was developed to

address an unserved medical need in the southern Nevada community a need

that is had by Petitioner and those similarly situated to her.

Based on this context, UNLV recruited the NCP program, applied for

additional funds from HRSA for the ongoing operations of the program, and

has accepted those funds. Those acts appear to have created a contract

between UNLV and HRSA with respect to the administration of the HRSA

grant to funds the NCP program. A contract can be the basis of a property

right. Perry v. Sindermann, 408 U.S. 593, 601, 92 S.Ct. 2694 (1972),

overruled in part on other grounds by Rust v. Sullivan, 500 U.S. 173, 111

S.Ct. 1759, 114 L.Ed.2d 233 (1991).

Petitioner is a third party beneficiary of that contract. The contract was

to provide the funding for UNLV to operate the NCP program through July,

2018. See Exhibit A. At the very least, Petitioner has a reasonable belief

19
that she would have access to the NCP program through that time. The

termination of the program in September, 2017, interfered with that right.

Should this Court agree with this argument, then it must agree that the

Respondents actions violated Petitioners due process rights, as it is

undisputed that she, and the other 65+ similarly situated patients had no notice

or opportunity to be heard before UNLV unilaterally shuttered the NCP

program. For this reason, this Court should issue a writ of mandamus

compelling UNLV to resume the NCP program.

D. PETITIONER SHOULD BE AWARDED ATTORNEYS FEES

AND COSTS FOR BRINGING THIS PETITION

Generally, attorney fees are not recoverable absent authority under a

statute, rule, or contract. Albios v. Horizon Communities, Inc., 122 Nev. 409,

417, 132 P.3d 1022, 1028 (2006). But, [a]s an exception to the general rule,

attorney fees may be awarded as special damages in limited circumstances.

Horgan v. Felton, 123 Nev. 577, 579, 170 P.3d 982, 983 (2007). In cases

where monetary damages are not an issue, such as actions to clear clouds on

title, such fees have been permitted. Id.

While there is a statute that allows a prevailing party may be awarded

attorney fees when she has not recovered more than $20,000, NRS

20
18.010(2)(a), such would not be available to Petitioner if she prevails in this

matter. That is because our courts have interpreted this provision as requiring

a money judgment as a prerequisite to recovering attorney fees. See e.g.,

Woods v. Label Investment Corp., 107 Nev. 419, 427, 812 P.2d 1293, 1299

(1991) ([A] money judgment is a prerequisite to an award of attorney's fees

under [NRS 18.010(2)(a) ].); Key Bank v. Donnels, 106 Nev. 49, 53, 787

P.2d 382, 385 (1990) (holding that [b]ecause respondents did not recover a

money judgment below, they cannot recover attorney fees under NRS

18.010(2)(a)); McCracken v. Cory, 99 Nev. 471, 473, 664 P.2d 349, 350

(1983) (holding that because the plaintiff did not request money damages, the

district court had no authority to award attorney fees under NRS

18.010(2)(a)); City of Las Vegas v. Cragin Industries, 86 Nev. 933, 940, 478

P.2d 585, 590 (1970) (declining to award plaintiff attorney fees under NRS

18.010(2)(a) because plaintiff did not recover a money judgment and that

statute as a condition precedent requires the award of a money judgment),

disapproved of on other grounds by Sandy Valley Assocs. v. Sky Ranch

Estates, 117 Nev. 948, 35 P.3d 964 (2001).

Like Nevada, in the federal court system, the U.S. Supreme Court has

affirmed the rule that litigants ordinarily bear their own attorneys fees

regardless of the outcome of the litigation. Buckhannon Bd. & Care Home,

21
Inc. v. W. Va. Dept of Health & Human Res., 532 U.S. 598, 602-03 (2001),

superseded in part by statute, Open Government Act of 2007, Pub. L. No.

110-175, 121 Stat. 2524 (codified at 5 U.S.C. 552(a)(4)(E) (2009)). There

are exceptions, however, to this so-called American Rule. For instance,

the American Rule does not apply where there is an explicit statutory basis

for awarding fees. Id. (citing Alyeska Pipeline Serv. Co. v. The Wilderness

Socy, 421 U.S. 240, 257 (1975), superseded by statute on other grounds,

Civil Rights Attorneys Fees Awards Act of 1976, Pub. L. No. 106-274,

4(d), 114 Stat. 803, 804 (codified at 42 U.S.C. 1988(b) (2000))); see also,

42 U.S.C. 1988. In the area of constitutional violations, fees for a prevailing

plaintiff are available pursuant to 42 U.S.C. 1988.

Prior to 1975, federal courts would award attorneys fees in absence of

explicit statutory basis for awarding fees under the private attorney general

theory. A private attorney general is an informal term usually used today

to refer to a private attorney who brings a lawsuit considered to be in the

public interest, i.e., benefiting the general public and not just the plaintiff.

The attorney is considered a private attorney general and may, at the

equitable discretion of the court, be entitled to recover attorneys fees if he

or she prevails. The rationale behind this principle is to provide extra

22
incentive to private attorneys to pursue suits that may be of benefit to society

at large.

In 1975, however, the U.S. Supreme Court stopped awarding fees

under this theory because it felt that such was under the purview of Congress.

See Alyeska, 421 U.S. at 257. A year later, Congress codified the private

attorney general principle into law with the enactment of Civil Rights

Attorneys Fees Award Act of 1976, 42 U.S.C. 1988.

This Court, however, must not view Alyeska, supra, as a bar to

granting the fees requested in this writ petition, if Petitioner is successful,

but, rather, justification. The Court in Alyeska went into painstaking detail

to provide the history of attorney fees awards by the Courts. Id. In doing so,

the Court started in the late eighteenth century, noting that:

In 1796, this Court appears to have ruled that the

Judiciary itself would not create a general rule,
independent of any statute, allowing awards of
attorneys fees in federal courts. In Arcambel v.
Wiseman, 3 U.S. (3 Dall.) 306, 1 L.Ed. 613, the
inclusion of attorneys fees as damages was
overturned on the ground that (t)he general practice
of the United States is in oposition (sic) to it; and
even if that practice were not strictly correct in
principle, it is entitled to the respect of the court, till
it is changed, or modified, by statute. This Court
has consistently adhered to that early holding. See
Day v. Woodworth, 13 How. 363, 14 L.Ed. 181
(1852); Oelrichs v. Spain, 15 Wall. 211, 21 L.Ed.
43 (1872); Flanders v. Tweed, 15 Wall. 450, 21
L.Ed. 203 (1873); Stewart v. Sonneborn, 98 U.S.
23
 187, 25 L.Ed. 116, 40 L.Ed.2d 703 (1879);
Fleischmann Distilling Corp. v. Maier Brewing Co.,
386 U.S. 714, 717713, 87 S.Ct. 1404, 18 L.Ed.2d
475 (1967); F.D. Rich Co., Inc. v. United States ex
rel. Industrial Lumber Co., Inc., 417 U.S. 116,
126131, 94 S.Ct. 2157, 21632166 (1974).

Id. at 249-250. The Court, throughout its opinion in Alyeska, notes that the

power to award fees is a power that must be granted by Congress. Id. at 262

(Under this scheme of things, it is apparent that the circumstances under

which attorneys fees are to be awarded and the range of discretion of the

courts in making those awards are matters for Congress to determine.). See

28 U.S.C. 123.

This Court, however, should not reject the private attorney general

theory for the same reasons that the U.S. Supreme Court did because Nevada

has a different constitutional basis for its courts than that of the federal courts.

The Nevada Constitution is far more expansive on the powers of the courts

than that of the U.S. Constitution. Compare Art. III Sec. 1 of US.

Constitution (The judicial Power of the United States, shall be vested in one

supreme Court, and in such inferior Courts as the Congress may from time

to time ordain and establish.) (emphasis added) with Art. VI, Sec 1 of the

Nevada Constitution (The judicial power of this State is vested in a court

system, comprising a Supreme Court, a court of appeals, district courts and

justices of the peace.). Whereas the powers of all of the federal courts
24
(except the U.S. Supreme Court) are vested in Congress, the powers of the

Nevada courts are left to the judiciary. To that end, the U.S. Supreme Court

had no choice but to defer to Congress for the authority to award fees; Nevada

is not limited in the same manner.

It is for that reason, that the Nevada Supreme Court has made

exceptions to the general rule that attorney fees are not recoverable absent

authority under a statute, rule, or contract. Albios, 122 Nev. at 417, 132 P.3d

at 1028. Specifically, the Nevada Supreme Court has stated that, [a]s an

exception to the general rule, attorney fees may be awarded as special

damages in limited circumstances. Horgan, 123 Nev. at 583, 170 P.3d at

986. In cases where monetary damages are not an issue, such as actions to

clear clouds on title, such fees have been permitted. Id.

Other states have permitted recovery of fees under the private

attorney general theory. See, generally, Hawaii (Gold Coast Neighborhood

Assn v. State, No. CAAP-14-0000472 (Haw. App., 2015); Illinois (Fox

Valley Families Against Planned Parentood v. Planned Parenthood of Ill., ,

LLC, 2015 IL App (2d) 131019 (Ill. App., 2015)); Minnesota (Minn. Stat.

8.31, subd. 3a (2014)); Utah (Pepperwood Homeowners Assn v. Mitchell,

2015 UT App 137 (Utah App., 2015) (An award of fees under the private-

attorney-general doctrine is appropriate only when the vindication of a

25
strong or societally important public policy takes place and the necessary

costs in doing so transcend the individual plaintiffs pecuniary interests to an

extent requiring subsidization.) (citing Carrier v. Salt Lake County, 2004

UT 98, 104 P.3d 1208 (Utah, 2004)); Pennsylvania (Society Created to

Reduce Urban Blight (SCRUB) v. Zoning Board of Adjustment of the City

of Philadelphia, 729 A.2d 117, 121 n.13 (Pa. Cmwlth. 1999)); Arizona

(Arnold v. Ariz. Dept. of Health Servs., 160 Ariz. 593, 609, 775 P.2d 521,

537 (1989) (The purpose of the private attorney general doctrine is to

promote vindication of important public rights.).

It is well known that Nevada courts often looks towards California for

how they approached issues of first impression. California courts accepted

the private attorney general doctrine of attorney fees developed in prior

judicial decisions before the California legislature codified the theory. See

Maria P. v. Riles, 43 Cal.3d 1281, 240 Cal.Rptr. 872 (Cal., 1987) (citing

Woodland Hills Residents Assn., Inc. v. City Council, 23 Cal.3d 917, 933,

154 Cal.Rptr. 503, 593 P.2d 200. (Cal.Sup.Ct.1979)). Under this theory,

attorney fees are available when the successful party proves each of the

following: (1) its lawsuit has resulted in the enforcement of an important right

affecting the public interest; (2) a significant benefit, whether pecuniary or

nonpecuniary, has been conferred on the general public or a large class of

26
persons; and (3) the necessity and financial burden of private enforcement

make the award appropriate. See California Code of Civil Procedure

1021.5; see also, Press v. Lucky Stores, Inc. 34 Cal.3d 311, 317-318

(Ca.Sup.Ct.1983); Roybal v. Governing Bd. of Salinas City Elem. School

Dist. 159 Cal.App.4th 1143, 1147(Ca.Ct.App.2008)).

This writ petition meets this California test for awarding fees under the

private attorney general theory. The NCP is a critical program to southern

Nevadas public health. Not only has it proven to be an extremely successful

program at decreasing, if not eliminating mother-to-child transmission of the

HIV virus, it is responsible for the on-going monitoring and care for over 65

pediatric and young adult patients who have very complex health needs.

While the NCP program actively services 65+ patients, it provides teaching

and educational services to over 200 medical providers a year, as well as on-

call services to 10 regional labor and delivery departments. It has a large

benefit on our entire society in southern Nevada.

While HafterLaw has agree to take this case without expectation for

compensations unless it is awarded by this Court, we cannot rely on the

generosity of our attorneys to champion these critical legal battles. Prior to

being put in contact with HafterLaw, Petitioners mother sought legal help

from numerous attorneys. Because of the lack of ability to pay for hourly

27
work, no attorney would agree to advocate for Petitioners rights. We cannot

risk that these types of cases will not be heard because private citizens cannot

afford access to our courts.

For these reasons, Petitioner respectfully requests that, if she is

successful in bringing this writ petition, this Court also award her fees and

costs for having to bring this writ petition.

E. AS TIME IS OF THE ESSENCE, THIS COURT SHOULD

EXPEDITE THE REVIEW OF THIS PETITION

As discussed above, with the closing of the NCP program, Petitioner,

and the 65+ patients who receive regular medical monitoring and treatment

for their complex HIV related medical needs will have no way to access the

critical health care that they need. As such, they cannot obtain refills on their

HIV specific medications, as their primary care physicians are not competent

nor comfortable with prescribing this complex medical regimens. Currently,

Petitioner, and others similarly situated, are in a grave danger of running out

of their life saving medications. However, the NCP program provides more

than just access to drugs; it provides complete care in a full, uninterrupted and

undivided attention of a physician and nurse practitioner that have extensive

training and experience managing the complex health care needs of HIV

28
patients. It is this care, attention to detail and unfettered access to her tailored

health care management that the Petitioner, and those 65+ similarly situated

patients no longer have.

Accordingly, time is of the essence in addressing this matter. Petitioner

respectfully requests that this Court expedite the review of this writ petition,

ordering a prompt response from the Respondents, and setting this matter for

hearing at the earliest possible opportunity.

CONCLUSION

For the foregoing reasons, Petitioner seeks a writ of mandamus ordering

the UNIVERSITY OF NEVADA, LAS VEGAS, a Nevada Public Entity /

Institution, and SHAWN GERSTENBERGER, in his official capacity as

Dean of the UNLV School of Community Health Services and the Dean of

the University of Medicine, to immediately reinstate the Nevada Care

Program, as set forth in the grant which was awarded pursuant to the Ryan

White HIV/AIDS Program, as administered and funded by HRSA.

///

///

///

29
 Petitioner also requests that this Court order that the Respondents pay

for Petitioners fees and costs for having to bring this writ petition.

DATED THIS 26TH day of October, 2017.

HAFTERLAW

By: __________________________
JACOB L. HAFTER, ESQ.
Nevada Bar Number 9303
6851 W. Charleston Boulevard
Las Vegas, Nevada 89117
Counsel for Petitioner

30
EXHIBIT A

EXHIBIT A
 1.DATEISSUED: 2.PROGRAMCFDA:93.153
01/04/2017
3.SUPERSEDESAWARDNOTICEdated:07/19/2016
exceptthatanyadditionsorrestrictionspreviouslyimposedremainineffectunlessspecificallyrescinded.

4a.AWARDNO.: 4b.GRANTNO.: 5.FORMERGRANT

4H12HA301090102 H12HA30109 NO.: NOTICEOFAWARD
2H12HA248320400 AUTHORIZATION(Legislation/Regulation)
PublicHealthServiceAct,Section2671
6.PROJECTPERIOD:
PublicHealthServiceAct,Section2671,42USC300ff71
FROM:06/01/2016THROUGH:07/31/2017
Sections2671and2693etseqofTitleXXVIofthePublicHealth
ServiceAct,asamendedbytheRyanWhiteHIV/AIDSTreatment
Ext.
Sections2671and2693ofTitleXXVIofthePublicHealthService
7.BUDGETPERIOD: Act(42U.S.C.300ff71etseq.),asamendedbytheRyanWhite
FROM:06/01/2016THROUGH:07/31/2016 HIV/AIDSTreatmentExtensionActof2009P.L.11187
Section2671ofTitleXXVIofthePublicHealthServiceAct(42
U.S.C.300ff71),asamendedbytheRyanWhiteHIV/AIDS
TreatmentExtensionActof2009(P.L.11187)

8.TITLEOFPROJECT(ORPROGRAM):RyanWhiteTitleIVWomen,Infants,Children,YouthandAffectedFamilyMembersAIDSHealthcare
9.GRANTEENAMEANDADDRESS: 10.DIRECTOR:(PROGRAMDIRECTOR/PRINCIPAL
UniversityofNevadaLasVegas INVESTIGATOR)
4505SMarylandPkwy EchezonaEzeanolue
LasVegas,NV891549900 UniversityofNevadaLasVegas
DUNSNUMBER:
098377336 LasVegas
11.APPROVEDBUDGET:(ExcludesDirectAssistance) 12.AWARDCOMPUTATIONFORFINANCIALASSISTANCE:
[X] GrantFundsOnly a.AuthorizedFinancialAssistanceThisPeriod $198,244.00
[] Totalprojectcostsincludinggrantfundsandallotherfinancialparticipation b.LessUnobligatedBalancefromPriorBudget
Periods
a. SalariesandWages: $115,355.00
i.AdditionalAuthority $0.00
b. FringeBenefits: $36,694.00
ii.Offset $0.00
c. TotalPersonnelCosts: $152,049.00
c.UnawardedBalanceofCurrentYear'sFunds $0.00
d. ConsultantCosts: $0.00
d.LessCumulativePriorAwards(s)ThisBudget $198,244.00
e. Equipment: $0.00 Period
f. Supplies: $0.00 e.AMOUNTOFFINANCIALASSISTANCETHIS $0.00
ACTION
g. Travel: $8,164.00
13.RECOMMENDEDFUTURESUPPORT:(Subjecttothe
h. Construction/AlterationandRenovation: $0.00
availabilityoffundsandsatisfactoryprogressofproject)
i. Other: $22,010.00 YEAR TOTALCOSTS
j. Consortium/ContractualCosts: $0.00 02 $176,234.00
k. TraineeRelatedExpenses: $0.00
14.APPROVEDDIRECTASSISTANCEBUDGET:(Inlieuofcash)
l. TraineeStipends: $0.00
a.AmountofDirectAssistance $0.00
m b.LessUnawardedBalanceofCurrentYear'sFunds $0.00
TraineeTuitionandFees: $0.00
.
c.LessCumulativePriorAwards(s)ThisBudgetPeriod $0.00
n. TraineeTravel: $0.00
d.AMOUNTOFDIRECTASSISTANCETHISACTION $0.00
o. TOTALDIRECTCOSTS: $182,223.00
p. INDIRECTCOSTS(Rate:%ofS&W/TADC): $16,021.00
q. TOTALAPPROVEDBUDGET: $198,244.00
i.LessNonFederalShare: $0.00
ii.FederalShare: $198,244.00
15.PROGRAMINCOMESUBJECTTO45CFR75.307SHALLBEUSEDINACCORDWITHONEOFTHEFOLLOWINGALTERNATIVES:
A=AdditionB=DeductionC=CostSharingorMatchingD=Other [A]
EstimatedProgramIncome:$0.00
16.THISAWARDISBASEDONANAPPLICATIONSUBMITTEDTO,ANDASAPPROVEDBYHRSA,ISONTHEABOVETITLEDPROJECT
ANDISSUBJECTTOTHETERMSANDCONDITIONSINCORPORATEDEITHERDIRECTLYORBYREFERENCEINTHEFOLLOWING:
a.Thegrantprogramlegislationcitedabove.b.Thegrantprogramregulationcitedabove.c.Thisawardnoticeincludingtermsandconditions,ifany,notedbelowunderREMARKS.d.45CFRPart75as
applicable.Intheeventthereareconflictingorotherwiseinconsistentpoliciesapplicabletothegrant,theaboveorderofprecedenceshallprevail.Acceptanceofthegranttermsandconditionsis
acknowledgedbythegranteewhenfundsaredrawnorotherwiseobtainedfromthegrantpaymentsystem.

REMARKS:(OtherTermsandConditionsAttached[X]Yes[]No)
Correctioninbudgetperiodstartdate.
ElectronicallysignedbyBradBarney,GrantsManagementOfficeron:01/04/2017
17.OBJ.CLASS:41.51 18.CRSEIN:1886000024A3 19.FUTURERECOMMENDEDFUNDING:$0.00
SUB
SUBPROGRAM
FYCAN CFDA DOCUMENTNO. AMT.FIN.ASST. AMT.DIR.ASST. ACCOUNT
CODE
CODE

Page 1
A printer version document only. The document may contain some accessibility challenges for the screen reader users. To access same information, a fully 508 compliant accessible HTML version is available on the HRSA Electronic Handbooks. If you need more
information, please contact HRSA contact center at 877-464-4772, 8 am to 8 pm ET, weekdays.
NOTICE OF AWARD (Continuation Sheet) Date Issued: 1/4/2017 10:45:20 AM
Award Number: 4 H12HA30109-01-02

15PD
143770892 93.153 15H12HA30109 $0.00 $0.00 N/A
CSARWICY

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NOTICE OF AWARD (Continuation Sheet) Date Issued: 1/4/2017 10:45:20 AM
Award Number: 4 H12HA30109-01-02

HRSAElectronicHandbooks(EHBs)RegistrationRequirements
TheProjectDirectorofthegrant(listedonthisNoA)andtheAuthorizingOfficialofthegranteeorganizationarerequiredtoregister(ifnot
alreadyregistered)withinHRSA'sElectronicHandbooks(EHBs).RegistrationwithinHRSAEHBsisrequiredonlyonceforeachuserforeach
organizationtheyrepresent.Tocompletetheregistrationquicklyandefficientlywerecommendthatyounotethe10digitgrantnumberfrombox
4bofthisNoA.Afteryouhavecompletedtheinitialregistrationsteps(i.e.,createdanindividualaccountandassociateditwiththecorrect
granteeorganizationrecord),besuretoaddthisgranttoyourportfolio.ThisregistrationinHRSAEHBsisrequiredforsubmissionof
noncompetingcontinuationapplications.Inaddition,youcanalsouseHRSAEHBstoperformotheractivitiessuchasupdatingaddresses,
updatingemailaddressesandsubmittingcertaindeliverableselectronically.Visit
https://grants3.hrsa.gov/2010/WebEPSExternal/Interface/common/accesscontrol/login.aspxtousethesystem.Additionalhelpisavailableonline
and/orfromtheHRSACallCenterat877Go4HRSA/8774644772.

TermsandConditions
Failuretocomplywiththeremarks,terms,conditions,orreportingrequirementsmayresultinadrawdownrestrictionbeingplaced
onyourPaymentManagementSystemaccountordenialoffuturefunding.

GrantSpecificTerm(s)
1. ThisrevisedNoticeofAwardisissuedtocorrecttheBudgetPeriodandProjectPeriodStartdatefrom06/01/2012to06/01/2016.
Allpriortermsandconditionsremainineffectunlessspecificallyremoved.

Contacts

NoAEmailAddress(es):
Name Role Email
KarenASmith AuthorizingOfficial karens@unr.edu
EchezonaEzeanolue ProgramDirector echezona.ezeanolue@unlv.edu
JeanetteSnyder PointofContact jeanette.bernardsnyder@unlv.edu
Note:NoAemailedtotheseaddress(es)

ProgramContact:
Forassistanceonprogrammaticissues,pleasecontactEliseYoungat:
HRSA/HAB/DCHAP
5600FishersLn
RM09N42
Rockville,MD,208521750
Email:eyoung@hrsa.gov
Phone:(301)4433812

DivisionofGrantsManagementOperations:
Forassistanceongrantadministrationissues,pleasecontactNancyGainesat:
MailStopCode:18105
HRSA/OFAM/DGMO
5600FishersLn
Rockville,MD,208521750
Email:ngaines@hrsa.gov
Phone:(301)4435382

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