It was this unfunded mandate to local governments that caused the Senate to reconsider the measure Monday and place it on the chief clerk's desk, where it will die by April 24 if not passed out to the Assembly.

The bill passed the Senate 12-9 Friday, but Sen. Mark Amodei, R-Carson City, asked for it to be reconsidered because of the unfunded mandate. On a party line 11-10 vote Monday, the bill was put in legislative limbo.

Amodei and Sen. Randolph Townsend, R-Reno, had voted for the bill Friday. Both expressed concerns about the mandate to local governments, however.

After the cancer vaccine bill was put on the desk, Titus tried to force reconsideration of an unrelated measure favored by Senate Majority Leader Bill Raggio, R-Reno, calling for the appointment of district judges and Supreme Court justices. Titus said her effort was not because of politics. But she failed Tuesday to gain enough support to amend the measure, so it has gone to the Assembly.

Titus said she will try to amend the vaccine bill to erase the concern about an unfunded mandate to local government and allow for its passage, but she was not happy that some local governments were opposed to offering the vaccine.

"I'm going to take the local governments out of it, and there will be no fiscal note," she said. "And that should address Sen. Townsend's concerns."

But, Titus added, "The local governments who oppose doing this do cover prostate cancer screenings, which are much more expensive than the cervical cancer vaccinations. I'm going to shame them. I hope they look real bad because they should."

Nine other Republicans voted against the bill Friday because of the mandate that insurance companies provide the vaccine, so any vote on the measure could still be close.

Sabra Smith-Newby, a lobbyist for Clark County, said the county's opposition comes only because the members of the self-funded plan decide what should be covered.

"To mandate coverage goes against our self-governed plan," she said. "Our members would make that determination."

Smith-Newby said the county has estimated the benefit would cost it $215,000. The vaccine requires three injections at $120 per injection for a total of $360 per person, she said.

Ted Olivas, a lobbyist for the city of Las Vegas, said the city is not opposed to the mandate. The cost of the vaccine is far outweighed by its preventive nature and the costs associated with cancer treatment, he said. The city is looking at adding the vaccine on its own, Olivas said.