Effective Date of Rule: Thirty-one days after filing.

     Purpose: WAC 246-853-600/246-854-200 Sexual misconduct and WAC 246-853-610/246-854-210 Abuse, the rules establish consistent and enforceable definitions of abuse and sexual misconduct with current or former patients of osteopathic physicians and physician assistants. The rules will help the practitioners avoid inappropriate behavior and will educate the public on the type of behavior expected of their practitioner.

     Statutory Authority for Adoption: RCW 18.57.005, 18.130.050.

     Other Authority: Chapters 18.57, 18.57A RCW.

      Adopted under notice filed as WSR 06-24-138 on December 6, 2006.

     Changes Other than Editing from Proposed to Adopted Version: Language was added noting that the definitions of "osteopathic physician," "patient" and "key third party" in new WAC 246-853-600 apply to the same terms in new WAC 246-853-610, and the definitions of "osteopathic physician assistant," "patient" and "key third party" in new WAC 246-854-200 apply to the same terms in WAC 246-854-210. These revisions clarify the rules without changing their intent.

     A final cost-benefit analysis is available by contacting Arlene Robertson, P.O. Box 47866, Olympia, WA 98504-7866, phone (360) 236-4945, fax (360) 236-2406, e-mail arlene.robertson@doh.wa.gov.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 4, Amended 0, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 4, Amended 0, Repealed 0.

     Date Adopted: June 5, 2007.

Blake T. Maresh

Executive Director

OTS-8770.2

NEW SECTION
WAC 246-853-600   Sexual misconduct.   (1) Definitions:

     (a) "Patient" means a person who is receiving health care or treatment, or has received health care or treatment without a termination of the osteopathic physician-patient relationship. The determination of when a person is a patient is made on a case-by-case basis with consideration given to a number of factors, including the nature, extent and context of the professional relationship between the osteopathic physician and the person. The fact that a person is not actively receiving treatment or professional services is not the sole determining factor.

     (b) "Osteopathic physician" means a person licensed to practice osteopathic medicine and surgery under chapter 18.57 RCW.

     (c) "Key third party" means a person in a close personal relationship with the patient and includes, but is not limited to, spouses, partners, parents, siblings, children, guardians and proxies.

     (2) An osteopathic physician shall not engage in sexual misconduct with a current patient or a key third party. An osteopathic physician engages in sexual misconduct when he or she engages in the following behaviors with a patient or key third party:

     (a) Sexual intercourse or genital to genital contact;

     (b) Oral to genital contact;

     (c) Genital to anal contact or oral to anal contact;

     (d) Kissing in a romantic or sexual manner;

     (e) Touching breasts, genitals or any sexualized body part for any purpose other than appropriate examination or treatment;

     (f) Examination or touching of genitals without using gloves;

     (g) Not allowing a patient the privacy to dress or undress;

     (h) Encouraging the patient to masturbate in the presence of the osteopathic physician or masturbation by the osteopathic physician while the patient is present;

     (i) Offering to provide practice-related services, such as medication, in exchange for sexual favors;

     (j) Soliciting a date;

     (k) Engaging in a conversation regarding the sexual history, preferences or fantasies of the osteopathic physician.

     (3) An osteopathic physician shall not engage in any of the conduct described in subsection (2) of this section with a former patient or key third party if the osteopathic physician:

     (a) Uses or exploits the trust, knowledge, influence, or emotions derived from the professional relationship; or

     (b) Uses or exploits privileged information or access to privileged information to meet the osteopathic physician's personal or sexual needs.

     (4) To determine whether a patient is a current patient or a former patient, the board will analyze each case individually, and will consider a number of factors, including, but not limited to, the following:

     (a) Documentation of formal termination;

     (b) Transfer of the patient's care to another health care provider;

     (c) The length of time that has passed;

     (d) The length of time of the professional relationship;

     (e) The extent to which the patient has confided personal or private information to the osteopathic physician;

     (f) The nature of the patient's health problem;

     (g) The degree of emotional dependence and vulnerability.

     (5) This section does not prohibit conduct that is required for medically recognized diagnostic or treatment purposes if the conduct meets the standard of care appropriate to the diagnostic or treatment situation.

     (6) It is not a defense that the patient, former patient, or key third party initiated or consented to the conduct, or that the conduct occurred outside the professional setting.

     (7) A violation of any provision of this rule shall constitute grounds for disciplinary action.

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     (a) Makes statements regarding the patient's body, appearance, sexual history, or sexual orientation that have no legitimate medical or therapeutic purpose;

     (b) Removes a patient's clothing or gown without consent;

     (c) Fails to treat an unconscious or deceased patient's body or property respectfully;

     (d) Engages in any conduct, whether verbal or physical, which unreasonably demeans, humiliates, embarrasses, threatens, or harms a patient.

     (2) A violation of any provision of this rule shall constitute grounds for disciplinary action.

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OTS-8771.2

NEW SECTION
WAC 246-854-200   Sexual misconduct.   (1) Definitions:

     (a) "Patient" means a person who is receiving health care or treatment, or has received health care or treatment without a termination of the osteopathic physician assistant-patient relationship. The determination of when a person is a patient is made on a case-by-case basis with consideration given to a number of factors, including the nature, extent and context of the professional relationship between the osteopathic physician assistant and the person. The fact that a person is not actively receiving treatment or professional services is not the sole determining factor.

     (b) "Osteopathic physician assistant" means a person licensed to practice osteopathic medicine and surgery under chapter 18.57A RCW.

     (c) "Key third party" means a person in a close personal relationship with the patient and includes, but is not limited to, spouses, partners, parents, siblings, children, guardians and proxies.

     (2) An osteopathic physician assistant shall not engage in sexual misconduct with a current patient or a key third party. An osteopathic physician assistant engages in sexual misconduct when he or she engages in the following behaviors with a patient or key third party:

     (a) Sexual intercourse or genital to genital contact;

     (b) Oral to genital contact;

     (c) Genital to anal contact or oral to anal contact;

     (d) Kissing in a romantic or sexual manner;

     (e) Touching breasts, genitals or any sexualized body part for any purpose other than appropriate examination or treatment;

     (f) Examination or touching of genitals without using gloves;

     (g) Not allowing a patient the privacy to dress or undress;

     (h) Encouraging the patient to masturbate in the presence of the osteopathic physician assistant or masturbation by the osteopathic physician assistant while the patient is present;

     (i) Offering to provide practice-related services, such as medication, in exchange for sexual favors;

     (j) Soliciting a date;

     (k) Engaging in a conversation regarding the sexual history, preferences or fantasies of the osteopathic physician assistant.

     (3) An osteopathic physician assistant shall not engage in any of the conduct described in subsection (2) of this section with a former patient or key third party if the osteopathic physician assistant:

     (a) Uses or exploits the trust, knowledge, influence, or emotions derived from the professional relationship; or

     (b) Uses or exploits privileged information or access to privileged information to meet the osteopathic physician assistant's personal or sexual needs.

     (4) To determine whether a patient is a current patient or a former patient, the board will analyze each case individually, and will consider a number of factors, including, but not limited to, the following:

     (a) Documentation of formal termination;

     (b) Transfer of the patient's care to another health care provider;

     (c) The length of time that has passed;

     (d) The length of time of the professional relationship;

     (e) The extent to which the patient has confided personal or private information to the osteopathic physician assistant;

     (f) The nature of the patient's health problem;

     (g) The degree of emotional dependence and vulnerability.

     (5) This section does not prohibit conduct that is required for medically recognized diagnostic or treatment purposes if the conduct meets the standard of care appropriate to the diagnostic or treatment situation.

     (6) It is not a defense that the patient, former patient, or key third party initiated or consented to the conduct, or that the conduct occurred outside the professional setting.

     (7) A violation of any provision of this rule shall constitute grounds for disciplinary action.

[]

     (a) Makes statements regarding the patient's body, appearance, sexual history, or sexual orientation that have no legitimate medical or therapeutic purpose;

     (b) Removes a patient's clothing or gown without consent;

     (c) Fails to treat an unconscious or deceased patient's body or property respectfully; or

     (d) Engages in any conduct, whether verbal or physical, which unreasonably demeans, humiliates, embarrasses, threatens, or harms a patient.

     (2) A violation of any provision of this rule shall constitute grounds for disciplinary action.

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