AN ACT Relating to the licensing and discipline of physicians and physicians' assistants; amending RCW 18.71.010, 18.71.015, 18.71.020, 18.71.025, 18.71.050, 18.71.051, 18.71.230, 18.71A.070, 18.72.100, 18.72.135, 18.72.155, 18.72.245, 18.72.250, 18.72.270, 18.72.380, 18.72.400, 43.24.020, 43.24.072, and 43.24.086; reenacting and amending RCW 18.71.040 and 18.71.080; and adding new sections to chapter 18.71 RCW.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

Sec. 1. Section 2, chapter 60, Laws of 1957 as last amended by section 51, chapter 158, Laws of 1979 and RCW 18.71.010 are each amended to read as follows:

The following terms used in this chapter shall have the meanings set forth in this section unless the context clearly indicates otherwise:

(1) "Board" means the board of medical examiners.

(2) ((~~"Director" means the director of licensing.~~

~~(3)~~)) "Resident physician" means an individual who has graduated from a school of medicine which meets the requirements set forth in RCW 18.71.055 and is serving a period of postgraduate clinical medical training sponsored by a college or university in this state or by a hospital accredited by this state. For purposes of this chapter, the term shall include individuals designated as intern or medical fellow.

Sec. 2. Section 2, chapter 284, Laws of 1961 as last amended by section 44, chapter 287, Laws of 1984 and RCW 18.71.015 are each amended to read as follows:

There is hereby created a board of medical examiners consisting of six individuals licensed to practice medicine in the state of Washington and one individual who is not a physician, to be known as the Washington state board of medical examiners.

The board shall be appointed by the governor. The members of the first board shall be appointed within thirty days after March 21, 1961, to serve the following terms: One member for one year, one member for two years, one member for three years, one member for four years, one member for five years, from the date of their appointment, or until their successors are duly appointed and qualified. On expiration of the term of any member, the governor shall appoint for a period of five years an individual of similar qualifications to take the place of such member. Each member shall hold office until the expiration of the term for which such member is appointed or until a successor shall have been appointed and shall have qualified.

Each member of the board shall be a citizen of the United States, must be an actual resident of this state, and, if a physician, must have been licensed to practice medicine in this state for at least five years.

The board shall meet as soon as practicable after appointment and elect a chairman and a secretary from its members. Meetings shall be held at least four times a year and at such place as the board shall determine and at such other times and places as the board deems necessary.

It shall require the affirmative vote of a majority of the members of the board to carry any motion or resolution, to adopt any rule, to pass any measure, or to authorize or deny the issuance of any certificate.

Each member of the board shall be compensated in accordance with RCW 43.03.240 and in addition thereto shall be reimbursed for travel expenses incurred in carrying out the duties of the board in accordance with RCW 43.03.050 and 43.03.060. Any such expenses shall be paid from funds appropriated to the ((~~department of licensing~~)) board.

Any member of the board may be removed by the governor for neglect of duty, misconduct, or malfeasance or misfeasance in office.

Vacancies in the membership of the board shall be filled for the unexpired term by appointment by the governor.

Sec. 3. Section 14, chapter 192, Laws of 1909 as last amended by section 1, chapter 55, Laws of 1977 and RCW 18.71.020 are each amended to read as follows:

Any person who shall practice or attempt to practice or hold himself out as practicing medicine in this state, without having, at the time of so doing, a valid, unrevoked license as provided in this chapter, shall be guilty of a gross misdemeanor: PROVIDED, That nothing in this section shall be so construed as to prohibit or penalize emergency lifesaving service rendered by a physician's trained mobile intravenous therapy technician, by a physician's trained mobile airway management technician, or by a physician's trained mobile intensive care paramedic, as defined in RCW 18.71.200 as now or hereafter amended, if such emergency lifesaving service be rendered under the responsible supervision and control of a licensed physician. In each such conviction the fine shall be paid, when collected, to the state treasurer: PROVIDED, That all fees, fines, forfeitures and penalties collected or assessed by a justice court because of the violation of a state law shall be remitted as provided in chapter 3.62 RCW as now exists or is later amended. The ((~~director~~)) board is authorized to prosecute all persons guilty of a violation of the provisions of this chapter.

Sec. 4. Section 10, chapter 284, Laws of 1961 as amended by section 4, chapter 171, Laws of 1975 1st ex. sess. and RCW 18.71.025 are each amended to read as follows:

The attorney general, each prosecuting attorney, ((~~the director,~~)) the state board of medical examiners, or any citizen of the state may in accordance with the laws of this state governing injunctions, maintain an action in the name of this state to enjoin such person from engaging in the practice of medicine as herein defined until a valid license to practice medicine be secured: PROVIDED, That such injunction shall not relieve such person so practicing medicine without a valid license from criminal prosecution therefor, but such remedy by injunction shall be in addition to the liability of such offender to criminal prosecution.

Sec. 5. Section 35, chapter 202, Laws of 1955 as amended by section 61, chapter 30, Laws of 1975 1st ex. sess. and by section 6, chapter 171, Laws of 1975 1st ex. sess. and RCW 18.71.040 are each reenacted and amended to read as follows:

Every applicant for a license to practice medicine shall pay an application fee ((~~of twenty-five dollars~~)) as determined by the board. In addition to the application fee provided for herein, every applicant for licensure by examination shall pay an examination fee of one hundred dollars, which sum shall be refunded in the event the board determines that the applicant is not eligible for examination. In addition to the application fee provided for herein, every applicant for licensure by reciprocity or waiver of examination shall pay a fee of fifty dollars. The ((~~director~~)) board shall charge a fee of fifteen dollars for license certifications.

Sec. 6. Section 3, chapter 60, Laws of 1957 as last amended by section 7, chapter 171, Laws of 1975 1st ex. sess. and RCW 18.71.050 are each amended to read as follows:

Each applicant who has graduated from a school of medicine located in any state, territory or possession of the United States, the District of Columbia, or the Dominion of Canada, shall file an application for licensure with the board ((~~on a form prepared by the director with the approval of the board~~)). Each applicant shall furnish proof satisfactory to the board of the following:

(1) That he has attended and graduated from a school of medicine approved by the board;

(2) That he has completed one year of postgraduate medical training in a program acceptable to the board;

(3) That he is of good moral character;

(4) That he is physically and mentally capable of safely carrying on the practice of medicine. The board may require any applicant to submit to such examination or examinations as it deems necessary to determine an applicant's physical and/or mental capability to safely practice medicine;

(5) That his license to practice medicine is not at the time of the application revoked or suspended by any licensing agency and that he has not been guilty of any conduct which would constitute grounds for refusal, revocation or suspension of such license under the laws of the state of Washington.

Nothing in this section shall be construed as prohibiting the board from requiring such additional information from applicants as it deems necessary.

Sec. 7. Section 16, chapter 171, Laws of 1975 1st ex. sess. and RCW 18.71.051 are each amended to read as follows:

Applicants for licensure to practice medicine who have graduated from a school of medicine located outside of the states, territories and possessions of the United States, the District of Columbia, or the Dominion of Canada, shall file an application for licensure with the board ((~~on a form prepared by the director with the approval of the board~~)). Each applicant shall furnish proof satisfactory to the board of the following:

(1) That he has completed in a school of medicine a resident course of professional instruction equivalent to that required in this chapter for applicants generally;

(2) That he meets all the requirements which must be met by graduates of the United States and Canadian school of medicine except that he need not have graduated from a school of medicine approved by the board;

(3) That he has satisfactorily passed the examination given by the educational council for foreign medical graduates or has met the requirements in lieu thereof as set forth in rules and regulations adopted by the board;

(4) That he has the ability to read, write, speak, understand, and be understood in the English language.

Sec. 8. Section 36, chapter 202, Laws of 1955 as amended by section 62, chapter 30, Laws of 1975 1st ex. sess. and by section 11, chapter 171, Laws of 1975 1st ex. sess., as last amended by sections 53, 54 and 55, chapter 158, Laws of 1979 and 18.71.080 are each reenacted and amended to read as follows:

Every person licensed to practice medicine in this state shall register with the ((~~director of licensing~~)) board annually, and pay an annual renewal registration fee determined by the ((~~director as provided in RCW 43.24.085 as now or hereafter amended~~)) board, on or before the first day of July of each year. The board may establish rules and regulations governing mandatory continuing education requirements which shall be met by physicians applying for renewal of licenses. Any failure to register and pay the annual renewal registration fee shall render the license invalid, but such license shall be reinstated upon written application therefor to the ((~~director~~)) board, and payment to the state of a penalty of ten dollars, together with all delinquent annual license renewal fees: PROVIDED, HOWEVER, That any person who fails to renew his license for a period of three years, shall in no event be entitled to renew his license under this section. Such a person in order to obtain a license to practice medicine in this state, shall file an original application as provided for in this chapter, along with the requisite fee therefor. The board, in its sole discretion, may permit such applicant to be licensed without examination if it is satisfied that such applicant meets all the requirements for licensure in this state, and is competent to engage in the practice of medicine.

Sec. 9. Section 2, chapter 110, Laws of 1973 1st ex. sess. as amended by section 57, chapter 158, Laws of 1979 and RCW 18.71.230 are each amended to read as follows:

A right to practice medicine and surgery by a Canadian physician in this state pursuant to RCW 18.71.030 shall be revocable by order of the ((~~director of licensing~~)) board upon a finding by the director of an act of unprofessional conduct as defined in RCW 18.72.030. Such physician shall have the same rights of notice, hearing and judicial review as provided licensed physicians generally pursuant to chapter 18.72 RCW.

Sec. 10. Section 3, chapter 190, Laws of 1975 1st ex. sess. as amended by section 58, chapter 158, Laws of 1979 and RCW 18.71A.070 are each amended to read as follows:

There shall be appointed by the ((~~director of licensing~~)) board an agent whose title shall be "medical practice investigator", who shall have the duty and shall be authorized to enter the clinic, office, or premises where a physician's assistant is employed for the purpose of inspecting the registration and utilization of any physician's assistant employed therein. Said investigator may serve and execute any notice or process issued under the authority of this chapter and shall perform any other duty prescribed by the director or the board, including assisting other agencies in enforcing the provisions of the law regulating the practice of medicine: PROVIDED, That funds must be included in the department's 1975-77 operational budget for this program.

Sec. 11. Section 10, chapter 202, Laws of 1955 as last amended by section 45, chapter 287, Laws of 1984 and RCW 18.72.100 are each amended to read as follows:

Members of the board shall be compensated in accordance with RCW 43.03.240 and shall be repaid their travel expenses while engaged in business of the board in accordance with RCW 43.03.050 and 43.03.060. Such compensation and reimbursement for expenses shall be paid out of the general fund on vouchers approved by the ((~~director of licensing~~)) board.

Sec. 12. Section 9, chapter 111, Laws of 1979 ex. sess. and RCW 18.72.135 are each amended to read as follows:

The ((~~director of licensing, upon request of the~~)) board, is authorized to appoint members pro tem for the purpose of participating as members of one or more panels of the board in connection with proceedings specifically identified in the appointment. While serving as medical disciplinary members pro tem, persons so appointed shall have all the authority, duties, and immunities, and shall be entitled to the emoluments, including travel expenses in accordance with RCW 43.03.050 and 43.03.060, of regular members of the board.

The chairperson of a panel shall be a regular member of the board.

Panels shall have authority to act as directed by the board with respect to all matters concerning the review, investigation, and adjudication of all complaints, allegations, charges, and matters subject to the jurisdiction of the board. Final decisions of board panels shall be subject to appeal as hereinafter provided. The authority to act through panels shall not restrict the authority of the board to act as a single body at any phase of proceedings within the board's jurisdiction.

Board panels shall have authority to make interim orders and to issue final decisions with respect to matters and cases delegated to a panel by the board. Final decisions may be appealed as provided in chapter 34.04 RCW.

Sec. 13. Section 6, chapter 111, Laws of 1979 ex. sess. and RCW 18.72.155 are each amended to read as follows:

((~~The director of the department of licensing shall appoint, from a list of three names supplied by the board,~~)) The board shall employ an executive secretary who ((~~shall act~~)) may or may not be a physician to carry out the provisions of this chapter. The ((~~director~~)) board shall also employ such additional staff including administrative assistants, investigators, and clerical staff as are required to enable the board to accomplish its duties and responsibilities. The executive secretary shall be exempt from the provisions of the civil service law, chapter 41.06 RCW, as now or hereafter amended.

Sec. 14. Section 13, chapter 111, Laws of 1979 ex. sess. and RCW 18.72.245 are each amended to read as follows:

Any portion or all of the costs associated with a preceptor for the monitoring of the conditions of probation or the license holder's compliance with the terms of the board's decision and order may be assessed by the board against the license holder, in which event the payment of the said costs and expenses shall become a legal obligation of the license holder to the ((~~department of licensing~~)) board, payment of which may be enforced in the superior or district courts.

Sec. 15. Section 25, chapter 202, Laws of 1955 as last amended by section 14, chapter 111, Laws of 1979 ex. sess. and RCW 18.72.250 are each amended to read as follows:

The filing by the board ((~~in the office of the director of licensing~~)) of an order pursuant to proceedings authorized by this chapter, after due notice, hearing, and findings in accordance with procedures specified in this chapter and chapter 34.04 RCW, or an order of summary suspension entered as authorized by this chapter, shall take effect immediately upon its filing. Such order, if appealed, shall not be stayed pending the appeal unless the board or the court to which the appeal is taken enters an order staying the order of the board, which stay may provide for terms necessary to protect the public.

Sec. 16. Section 27, chapter 202, Laws of 1955 and RCW 18.72.270 are each amended to read as follows:

The ((~~director of licensing~~)) board of medical examiners shall not issue any license or any renewal thereof to any person whose license has been revoked or suspended by the board except in conformity with the terms and conditions of the certificate or order of revocation or suspension, or in conformity with any order of reinstatement issued by the board, or in accordance with the final judgment in any proceeding for review instituted under the provisions of this chapter.

Sec. 17. Section 1, chapter 71, Laws of 1983 and RCW 18.72.380 are each amended to read as follows:

There is hereby levied to be collected by the ((~~department of licensing~~)) board of medical examiners from every physician and surgeon licensed pursuant to chapter 18.71 RCW an annual medical disciplinary assessment equal to the license renewal fee ((~~established under RCW 43.24.085~~)). The assessment levied pursuant to this subsection is in addition to any license renewal fee ((~~established under RCW 43.24.085~~)).

Sec. 18. Section 3, chapter 71, Laws of 1983 and RCW 18.72.400 are each amended to read as follows:

The ((~~director of licensing~~)) board shall allocate all appropriated funds to accomplish the purposes of this chapter.

Sec. 19. Section 43.24.020, chapter 8, Laws of 1965 as last amended by section 95, chapter 158, Laws of 1979 and RCW 43.24.020 are each amended to read as follows:

The director of licensing shall administer all laws with respect to the examination of applicants for, and the issuance of, licenses to persons to engage in any business, profession, trade, occupation, or activity, except physicians and surgeons licensed pursuant to chapter 18.71 RCW.

This shall include the administration of all laws pertaining to the regulation of securities and speculative investments.

Sec. 20. Section 5, chapter 168, Laws of 1983 and RCW 43.24.072 are each amended to read as follows:

There is created in the state treasury an account within the general fund to be known as the health professions account. All fees received by the department for health professions licenses, registration, certifications, renewals, or examinations shall be forwarded to the state treasurer who shall credit such moneys to the health professions account. All expenses incurred in carrying out the health professions licensing activities of the department shall be paid from the account as authorized by legislative appropriation. Any residue in the account shall be accumulated and shall not revert to the general fund at the end of the biennium.

The director shall biennially prepare a budget request based on the anticipated costs of administering the health professions licensing activities of the department which shall include the estimated income from health professions fees: PROVIDED, That the medical disciplinary board and the board of medical examiners jointly shall biennially prepare a budget request based on the anticipated costs of administering the two boards' activities which shall include the estimated income from fees and assessments.

Sec. 21. Section 12, chapter 168, Laws of 1983 and RCW 43.24.086 are each amended to read as follows:

It shall be the policy of the state of Washington that the cost of each professional, occupational or business licensing program be fully borne by the members of that profession, occupation or business. The director of licensing shall from time to time establish the amount of all application fees, license fees, registration fees, examination fees, permit fees, renewal fees, and any other fee associated with licensing or regulation of professions, occupations or businesses administered by the business and professions administration in the department of licensing. In fixing said fees, the director shall set the fees for each such program at a sufficient level to defray the costs of administering that program. All such fees shall be fixed by rule adopted by the director in accordance with the provisions of the administrative procedure act, chapter 34.04 RCW: PROVIDED, That the medical disciplinary board and the board of medical examiners shall establish fees and assessments in accordance with this section.

NEW SECTION. Sec. 22. A new section is added to chapter 18.71 RCW to read as follows:

The board shall employ an executive officer who shall not be a member of the board. Said officer shall receive compensation as set by the appropriate authority, and shall be responsible for:

(1) The administering of all professional and public affairs as directed by the board;

(2) Appointing, as authorized and delegated by the board, such secretarial, clerical, accounting, and other office assistance as necessary under provisions of chapter 41.06 RCW;

(3) Reporting to and carrying out all policies and instructions emanating from the board;

(4) Preparing and maintaining all board records;

(5) Attending to the correspondence of the board; and

(6) Receiving and receipting for all fees collected.

NEW SECTION. Sec. 23. A new section is added to chapter 18.71 RCW to read as follows:

The board may employ inspectors, investigators, physicians, attorneys, and other agents as necessary to assist it for any purpose which it may deem necessary.