BILL REQ. #:  H-3503.2 

READ FIRST TIME 01/28/14.   

     AN ACT Relating to creation of a quality improvement program for the licensees of the medical quality assurance commission; adding new sections to chapter 18.71 RCW; creating a new section; and providing an expiration date.

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

NEW SECTION.  Sec. 1   The legislature considers physicians and physician assistants as lifelong learners. The legislature further recognizes the nature of this learning, practice correction, and practice improvement typically occurs in an environment that is conducive to learning but not without consequence. This learning or guidance occurs at the direction of more learned peers. Historically, this would occur through the actions of professional associations intended to maintain and improve levels of competency through instruction and guidance. It was through this process that senior members of the association identified and addressed potentially harmful practice deficits before these deficits developed into habits that could harm the patient and by extension the profession. As not all licensed practitioners in the state of Washington are members of professional associations, but all medical practitioners are licensed by the medical quality assurance commission, it is appropriate that the commission fulfill the role of providing practice correction to those practitioners in need.

NEW SECTION.  Sec. 2   The definitions in this section apply throughout sections 3 through 9 of this act unless the context clearly requires otherwise.
     (1) "Nondisciplinary resolution" means a resolution authorized by sections 3 through 9 of this act.
     (2) "Practitioner" means a person licensed under this chapter or chapter 18.71A RCW.
     (3) "Quality improvement program" means a program that seeks to educate and improve practitioner proficiency with regard to quality of care, professional standards, ethical guidelines, and other practice standard issues established by the commission pursuant to sections 3 through 9 of this act. The quality improvement program consists of nondisciplinary and nonreportable tools for use by the commission at its discretion to resolve issues relating to medical practice.

NEW SECTION.  Sec. 3   (1) The commission shall conduct a pilot project to evaluate the efficacy of a nondisciplinary quality improvement program for its license holders. The purpose of the program is to address concerns in practice that do not constitute unprofessional conduct or pose a threat to patient safety. The goal of the program is to improve the care of practitioners in a nonpunitive environment that will result in safer and higher quality care to the citizens of this state. The quality improvement program is educational and nondisciplinary. The commission may initiate one or more elements of the quality improvement program with a practitioner at any time, including during the complaint process prior to the commission filing charges or allegations against a respondent.
     (2) The commission may initiate one or more elements of the quality improvement program with a practitioner through the formal complaint process, the investigative process, or concerns shared informally with the commission by peers, employers, or other concerned parties associated with the practitioner.
     (3) A nondisciplinary resolution may not:
     (a) Revoke, suspend, limit, or restrict a license or other authorization to practice medicine;
     (b) Assess an administrative penalty; or
     (c) Resolve a complaint:
     (i) Concerning a patient death or the commission of a felony;
     (ii) Concerning a matter in which the practitioner engaged in inappropriate sexual behavior or contact with a patient or became financially or personally involved with a patient in an inappropriate manner; or
     (iii) For which the appropriate resolution may involve a restriction on the manner in which the practitioner practices medicine.      (4) A nondisciplinary resolution is not a disciplinary action or adjudication. No failure to adhere to the applicable standard of care or violation of this chapter or chapter 18.71A RCW may be implied by participation in the quality improvement program or the adoption of a nondisciplinary resolution. A nondisciplinary resolution and entity records and findings pursuant to this section and sections 4 through 9 of this act are not admissible in any civil, criminal, or administrative action, except that a nondisciplinary resolution is admissible in any disciplinary proceeding by the commission.
     (5) A meeting of the commission for the purpose of discussing or adopting a nondisciplinary resolution under this section is not subject to the administrative procedure act, chapter 34.05 RCW, or the open public meetings act, chapter 42.30 RCW.

NEW SECTION.  Sec. 4   The establishment of the quality improvement program authorizes the commission to perform any or all of the following:
     (1) Entering into relationships supportive of the quality improvement program with professionals who provide the following services: Evaluation, education, or quality care improvement;
     (2) Receiving and assessing reports from any source raising issues with a practitioner's care or conduct that may need improvement;
     (3) Intervening in cases of questionable behavior or care, or in cases where there is reasonable cause to suspect there is a quality of care or behavior issue but not unprofessional conduct as set forth in RCW 18.130.180;
     (4) Upon reasonable cause, referring a practitioner for education or quality improvement;
     (5) Monitoring the education and quality improvement of a practitioner through meetings with the practitioner and individuals assisting the practitioner pursuant to this section;
     (6) Providing monitoring and continuing rehabilitative support of practitioners;
     (7) Performing such other activities as agreed upon by the commission and the practitioner; and
     (8) Providing education, prevention, or guidance where appropriate.

NEW SECTION.  Sec. 5   (1) The commission may enter into a written agreement with a practitioner for a professional development plan to resolve a concern, complaint, or investigation of a complaint received by the commission.     
     (2) The commission may issue a professional development plan to resolve a complaint against a practitioner only if the practitioner has not previously entered into a professional development plan within the last five years.
     (3) The practitioner participating in a professional development plan shall cover the cost of any education or other course of action required by the plan.

NEW SECTION.  Sec. 6   The commission may issue a letter of guidance to a practitioner to resolve a concern, complaint, or investigation of a complaint received by the commission. The letter of guidance may detail alleged areas of concern relating to medical practice of a practitioner and possible remedies the practitioner may undertake to educate himself or herself on the subject.

NEW SECTION.  Sec. 7   (1) The commission may compel a practitioner to attend an informal interview to resolve a concern, complaint, or investigation of a complaint received by the commission.
     (2) The purpose of the informal interview is to conduct a candid discussion between medical professionals regarding a specific area of practice or situation of concern relating to practice.
     (3) The practitioner may choose to attend the informal interview with legal representation.
     (4) An informal interview does not preclude the commission from proceeding with further investigation and disciplinary actions.

NEW SECTION.  Sec. 8   The commission shall adopt rules necessary to implement sections 2 through 7 of this act.

NEW SECTION.  Sec. 9   By December 1, 2015, the department of health and the commission shall submit a joint report to the appropriate committees of the legislature on the results of the pilot project. The report must include a recommendation of whether the quality improvement program should be extended to all health care professions listed in RCW 18.130.040.

NEW SECTION.  Sec. 10   If any provision of this act or its application to any person or circumstance is held invalid, the remainder of the act or the application of the provision to other persons or circumstances is not affected.

NEW SECTION.  Sec. 11   Sections 2 through 9 of this act are each added to chapter 18.71 RCW.

NEW SECTION.  Sec. 12   This act expires July 1, 2016.