52nd Legislature

                      1992 Regular Session

Passed by the House March 9, 1992

  Yeas 96   Nays 0




Speaker of the

       House of Representatives


Passed by the Senate March 6, 1992

  Yeas 48   Nays 0



I, Alan Thompson, Chief Clerk of the House of Representatives of the State of Washington, do hereby certify that the attached is ENGROSSED SUBSTITUTE HOUSE BILL 2337 as passed by the House of Representatives and the Senate on the dates hereon set forth.




President of the Senate

                               Chief Clerk



Approved Place Style On Codes above, and Style Off Codes below.





Governor of the State of Washington

                        Secretary of State

                       State of Washington



                       ENGROSSED SUBSTITUTE HOUSE BILL 2337



                             AS AMENDED BY THE SENATE


                     Passed Legislature - 1992 Regular Session


State of Washington              52nd Legislature             1992 Regular Session


By House Committee on Health Care (originally sponsored by Representatives Morris, Moyer, Paris, Casada, Franklin, Braddock, Ebersole, H. Myers, Schmidt, Appelwick, Ogden, Locke, Hargrove, Edmondson, D. Sommers, Cantwell, Hochstatter, Rasmussen, Forner, R. Johnson, Zellinsky, Rayburn, Nealey, Heavey, Wineberry, Chandler, Roland, J. Kohl, Ludwig, Mitchell, Orr, Spanel, May, Leonard, Haugen, Ferguson, Sprenkle, Miller, O'Brien and Anderson)


Read first time 01/27/92.Providing malpractice insurance for retired physicians serving low-income patients.

     AN ACT Relating to community clinics that utilize retired physicians to provide primary care to low-income persons without compensation; adding new sections to chapter 43.70 RCW; and creating a new section.




     NEW SECTION.  Sec. 1.      There are a number of retired physicians who wish to provide, or are providing, health care services to low-income patients without compensation.  However, the cost of obtaining malpractice insurance is a burden that is deterring them from donating their time and services in treating the health problems of the poor.  The necessity of maintaining malpractice insurance for those in practice is a significant reality in today's litigious society.

     A program to alleviate the onerous costs of malpractice insurance for retired physicians providing uncompensated health care services to low-income patients will encourage philanthropy and augment state resources in providing for the health care needs of those who have no access to basic health care services.

     An estimated sixteen percent of the nonelderly population do not have health insurance and lack access to even basic health care services.  This is especially problematic for low-income persons who are young and who are either unemployed or have entry-level jobs without health care benefits.  The majority of the uninsured, however, are working adults, and some twenty-nine percent are children.

     The legislature declares that this act will increase the availability of primary care to low-income persons and is in the interest of the public health and safety.


     NEW SECTION.  Sec. 2.  A new section is added to chapter 43.70 RCW to read as follows:

     (1) The department may establish a program to purchase and maintain liability malpractice insurance for retired physicians who provide primary health care services at community clinics.  The following conditions apply to the program:

     (a) Primary health care services shall be provided at community clinics that are public or private tax-exempt corporations;

     (b) Primary health care services provided at the clinics shall be offered to low-income patients based on their ability to pay;

     (c) Retired physicians providing health care services shall not receive compensation for their services; and

     (d) The department shall contract only with a liability insurer authorized to offer liability malpractice insurance in the state.

     (2) This section and section 3 of this act shall not be interpreted to require a liability insurer to provide coverage to a physician should the insurer determine that coverage should not be offered to a physician because of past claims experience or for other appropriate reasons.

     (3) The state and its employees who operate the program shall be immune from any civil or criminal action involving claims against clinics or physicians that provided health care services under this section and section 3 of this act.  This protection of immunity shall not extend to any clinic or physician participating in the program.

     (4) The department may monitor the claims experience of retired physicians covered by liability insurers contracting with the department.

     (5) The department may provide liability insurance under this act only to the extent funds are provided for this purpose by the legislature.


     NEW SECTION.  Sec. 3.  A new section is added to chapter 43.70 RCW to read as follows:

     The department may establish by rule the conditions of participation in the liability insurance program by retired physicians at clinics utilizing retired physicians for the purposes of this section and section 2 of this act.  These conditions shall include, but not be limited to, the following:

     (1) The participating physician associated with the clinic shall hold a valid license to practice medicine and surgery in this state and otherwise be in conformity with current requirements for licensure as a retired physician, including continuing education requirements;

     (2) The participating physician shall limit the scope of practice in the clinic to primary care.  Primary care shall be limited to noninvasive procedures and shall not include obstetrical care, or any specialized care and treatment.  Noninvasive procedures include injections, suturing of minor lacerations, and incisions of boils or superficial abscesses;

     (3) The provision of liability insurance coverage shall not extend to acts outside the scope of rendering medical services pursuant to this section and section 2 of this act;

     (4) The participating physician shall limit the provision of health care services to low-income persons provided that clinics may, but are not required to, provide means tests for eligibility as a condition for obtaining health care services;

     (5) The participating physician shall not accept compensation for providing health care services from patients served pursuant to this section and section 2 of this act, nor from clinics serving these patients.  "Compensation" shall mean any remuneration of value to the participating physician for services provided by the physician, but shall not be construed to include any nominal copayments charged by the clinic, nor reimbursement of related expenses of a participating physician authorized by the clinic in advance of being incurred; and

     (6) The use of mediation or arbitration for resolving questions of potential liability may be used, however any mediation or arbitration agreement format shall be expressed in terms clear enough for a person with a sixth grade level of education to understand, and on a form no longer than one page in length.