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

     Purpose: WAC 246-16-800 through 246-16-890, sanction schedule. These rules adopt a sanction schedule for disciplinary action in all credentialed health care professions as required by RCW 18.130.390.

     Statutory Authority for Adoption: RCW 18.130.390.

      Adopted under notice filed as WSR 09-10-089 on May 6, 2009.

     Changes Other than Editing from Proposed to Adopted Version: Tier descriptions in WAC 246-16-810 Practice below standard of care, 246-16-820 Sexual misconduct or contact, and 246-16-830 Abuse, were changed to clarify the differences between the tiers.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 8, Amended 0, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 8, Amended 0, Repealed 0.

     Date Adopted: July 22, 2009.

Mary C. Selecky

Secretary

OTS-2076.5

SANCTIONS
NEW SECTION
WAC 246-16-800   Sanctions -- General provisions.   (1) Applying these rules.

     (a) The disciplining authorities listed in RCW 18.130.040(2) will apply these rules to determine sanctions imposed for unprofessional conduct by a license holder in any active, inactive, or expired status. The rules do not apply to applicants.

     (b) The disciplining authorities will apply the rules in:

     (i) Orders under RCW 18.130.110 or 18.130.160; and

     (ii) Stipulations to informal disposition under RCW 18.130.172.

     (c) Sanctions will begin on the effective date of the order.

     (2) Selecting sanctions.

     (a) The disciplining authority will select sanctions to protect the public and, if possible, rehabilitate the license holder.

     (b) The disciplining authority may impose the full range of sanctions listed in RCW 18.130.160 for orders and RCW 18.130.172 for stipulations to informal dispositions.

     (i) Suspension or revocation will be imposed when the license holder cannot practice with reasonable skill or safety.

     (ii) Permanent revocation may be imposed when the disciplining authority finds the license holder can never be rehabilitated or can never regain the ability to practice safely.

     (iii) Surrender of a credential may be imposed when the license holder is at the end of his or her effective practice and surrender alone is enough to protect the public. The license holder must agree to retire and not resume practice.

     (iv) Indefinite suspension may be imposed in default and waiver of hearing orders. If indefinite suspension is not imposed in a default or waiver of hearing order, the disciplining authority shall impose sanctions determined according to these rules.

     (v) "Oversight" means a period of time during which respondent must engage in on-going affirmative conduct intended to encourage rehabilitation and ensure public safety. It also includes active compliance monitoring by the disciplining authority. The passage of time without additional complaints or violations, with or without payment of a fine or costs, is not, by itself, oversight.

     (c) The disciplining authority may deviate from the sanction schedules in these rules if the schedule does not adequately address the facts in a case. The disciplining authority will acknowledge the deviation and state its reasons for deviating from the sanction schedules in the order or stipulation to informal disposition.

     (d) If the unprofessional conduct is not described in a schedule, the disciplining authority will use its judgment to determine appropriate sanctions. The disciplining authority will state in the order or stipulation to informal disposition that no sanction schedule applies.

     (3) Using sanction schedules.

     (a) Step 1: The findings of fact in an order or the allegations in an informal disposition describe the unprofessional conduct. The disciplining authority uses the unprofessional conduct described to select the appropriate sanction schedule contained in WAC 246-16-810 through 246-16-860.

     (i) If the act of unprofessional conduct falls in more than one sanction schedule, the greater sanction is imposed.

     (ii) If different acts of unprofessional conduct fall in the same sanction schedule, the highest sanction is imposed and the other acts of unprofessional conduct are considered aggravating factors.

     (b) Step 2: The disciplining authority identifies the severity of the unprofessional conduct and identifies a tier using the sanction schedule tier descriptions.

     (c) Step 3: The disciplining authority identifies aggravating or mitigating factors using the list in WAC 246-16-890. The disciplining authority describes the factors in the order or stipulation to informal disposition.

     (d) Step 4: The disciplining authority selects sanctions within the identified tier. The starting point for duration of the sanctions is the middle of the tier range.

     (i) Aggravating factors move the appropriate sanctions towards the maximum end of the tier range.

     (ii) Mitigating factors move the appropriate sanctions towards the minimum end of the tier range.

     (iii) Mitigating or aggravating factors may result in determination of a sanction outside the range in the tier. The disciplining authority will state its reasons for deviating from the tier range in the sanction schedule in the order or stipulation to informal disposition. The disciplining authority has complied with these rules if it acknowledges the deviation and states its reasons for deviating from the sanction schedules in the order or stipulation to informal disposition.

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     (1) Factors related to the unprofessional conduct:

     (a) Gravity of the unprofessional conduct;

     (b) Age, capacity and/or vulnerability of the patient, client or victim;

     (c) Number or frequency of the acts of unprofessional conduct;

     (d) Injury caused by the unprofessional conduct;

     (e) Potential for injury to be caused by the unprofessional conduct;

     (f) Degree of responsibility for the outcome;

     (g) Abuse of trust;

     (h) Intentional or inadvertent act(s);

     (i) Motivation is criminal, immoral, dishonest or for personal gain;

     (j) Length of time since the unprofessional conduct occurred.

     (2) Factors related to the license holder:

     (a) Experience in practice;

     (b) Past disciplinary record;

     (c) Previous character;

     (d) Mental and/or physical health;

     (e) Personal circumstances;

     (f) Personal problems having a nexus with the unprofessional conduct.

     (3) Factors related to the disciplinary process:

     (a) Admission of key facts;

     (b) Full and free disclosure to the disciplining authority;

     (c) Voluntary restitution or other remedial action;

     (d) Bad faith obstruction of the investigation or discipline process or proceedings;

     (e) False evidence, statements or deceptive practices during the investigation or discipline process or proceedings;

     (f) Remorse or awareness that the conduct was wrong;

     (g) Impact on the patient, client, or victim.

     (4) General factors:

     (a) License holder's knowledge, intent, and degree of responsibility;

     (b) Presence or pattern of other violations;

     (c) Present moral fitness of the license holder;

     (d) Potential for successful rehabilitation;

     (e) Present competence to practice;

     (f) Dishonest or selfish motives;

     (g) Illegal conduct;

     (h) Heinousness of the unprofessional conduct;

     (i) Ill repute upon the profession;

     (j) Isolated incident unlikely to reoccur.

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