BP BHEAD INT H

AN ACT Relating to orthotic-prosthetic services; adding a new chapter to Title 18 RCW; creating a new section; and declaring an emergency.

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

NEW SECTION. Sec. 1. It is the intent of the legislature that sections 2 through 23 of this act accomplish the following: Safeguard public health, safety, and welfare; protect the public from being mislead by unethical, ill-prepared, unscrupulous, and unauthorized persons; assure the highest degree of professional conduct on the part of orthotists and prosthetists as well as orthotic and prosthetic assistants; and assure the availability of orthotic-prosthetic services of high quality to persons in need of the services. It is the purpose of sections 2 through 23 of this act to provide for the regulation of persons offering orthotic-prosthetic services to the public.

NEW SECTION. Sec. 2. Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.

(1) "Advisory committee" means orthotics and prosthetics advisory committee.

(2) "Department" means department of health.

(3) "Person" means an individual, partnership, an unincorporated organization, or corporate body, except that only an individual may be licensed under this chapter.

(4) "Secretary" means secretary of health.

(5) "Orthotics" means the science and practice of evaluating, measuring, designing, fabricating, assembling, fitting, adjusting, or servicing, as well as providing the initial training necessary to accomplish the fitting of an orthosis for the support, correction, or alleviation of neuromuscular or musculoskeletal dysfunction, disease, injury, or deformity. The practice of orthotics encompasses evaluation, treatment, and consultation.

Among classes of orthoses, there exist three major types:

(a) Custom-fabricated, also known as custom-made;

(b) Prefabricated, also known as custom-fitted, or as off-the-shelf; and

Using a body of knowledge from biomechanics, pathomechanics, material science, and specialized manufacturing processes, the orthotist uses levers, three-point force systems, hydrostatics, joint axis alignment, and axial loading techniques to achieve the goals of improving both static and dynamic balance as well as stability. As a science, orthotics includes the application of static and dynamic forces to the human frame in pressure tolerant areas and minimization of those forces in pressure intolerant areas. With basic postural and gait analysis, orthotists assess and design orthoses to maximize function, and provide not only the support but the alignment necessary in the sagittal, transverse, and coronal planes to either prevent or correct deformity or to improve the safety and efficiency of mobility or locomotion, or both. The practice of orthotics includes providing continuing patient care in order to assure proper fit and function of the orthotic device by periodic evaluation.

(6) "Orthotist" means a person licensed to practice orthotics under this chapter. An orthotist evaluates, measures, designs, fabricates, fits, services, and provides the initial training necessary to accomplish the fitting of orthoses that use static and dynamic forces for the support or correction of disabilities caused by neuro‑musculoskeletal diseases, injuries, or deformities.

(7) "Orthotic assistant" means a person licensed to assist in the practice of orthotics under the supervision or with the regular consultation of a licensed orthotist.

(8) "Orthotic aide" means a person who is trained to perform specific orthotic techniques under professional supervision as defined by the advisory committee but who does not perform activities that require advanced training in the sciences or practices involved in the profession of orthotics.

(9) "Orthosis" means a custom-fabricated, definitive brace or support that is designed for long-term use. "Orthosis" does not include the following assistive technology devices: Commercially available knee orthoses used following injury or surgery; spastic muscle tone-inhibiting orthoses; upper extremity adaptive equipment; finger splints; hand splints; face masks used following burns; wheelchair seating that is an integral part of the wheelchair and not worn by the patient; fabric or elastic supports; corsets; arch supports; low temperature-formed plastic splints; trusses; elastic hose; canes; crutches; cervical collars; dental appliances; or other similar devices commonly carried in stock by a pharmacy, department store, corset shop, or surgical supply facility.

(10) "Prosthetics" means the science and practice of evaluating, measuring, designing, fabricating, assembling, fitting, adjusting, or servicing as well as providing the initial training necessary to accomplish the fitting of a prosthesis through the replacement of external parts of a human body lost due to amputation or congenital deformities or absences. As a science, prosthetics includes the application of static and dynamic forces to human tissues in pressure-tolerant areas and minimization of pressures in pressure-intolerant areas. The practice of prosthetics also includes the generation of an image, form, or mold that replicates the patient's body or body segment and that requires rectification of dimensions, contours, and volumes for use in the design and fabrication of a socket to accept a residual anatomic limb to, in turn, create an artificial appendage that is designed to support either body weight or improve or restore function or cosmesis, or both. Involved in the practice of prosthetics is the clinical assessment of the requirements necessary for the most efficient center of gravity pathway using a knowledge of moments and torque to accomplish optimum alignment of joint axes and weightbearing load lines for safety and efficient function. The practice of prosthetics includes providing continuing patient care in order to assure proper fit and function of the prosthetic device by periodic evaluation.

(11) "Prosthetist" means a person who is licensed to evaluate, measure, design, fabricate, fit, and service as well as provide the initial training necessary to accomplish the fitting of prostheses to either improve or restore function or cosmesis, or both, through the replacement of external parts of the human body due to amputation or congenital deformities or absences.

(12) "Prosthetic assistant" means a person licensed to assist in the practice of prosthetics under the supervision or with the regular consultation of a licensed prosthetist.

(13) "Prosthetic aide" means a person who is trained to perform specific prosthetic techniques under professional supervision as defined by the advisory committee, but who does not perform activities that require advanced training in the sciences or practices that are involved in the profession of prosthetics.

(14) "Prosthesis" means a definitive artificial limb that is alignable, or articulated, or, in lower extremity applications, capable of weightbearing. "Prosthesis" means an artificial medical device that is not surgically implanted and that is used to replace a missing limb, appendage, or other external human body part including an artificial limb, hand, or foot. The term does not include artificial eyes, ears, fingers or toes, dental appliances, ostomy products, cosmetic devices such as artificial breasts, eyelashes, or wigs, or other devices that do not have a significant impact on the musculoskeletal functions of the body. In the lower extremity of the body, the term "prosthesis" does not include prostheses required for amputations distal to and including the transmetatarsal level. In the upper extremity of the body, the term "prosthesis" does not include prostheses that are provided to restore function for amputations distal to and including the carpal level.

(15) "Definitive" means a class of orthoses-prostheses that are durable in nature, whose design is appropriate for the duration of medical need.

(16) "Custom-made" means the design and fabrication from raw materials of a device for a specific patient and requires the generation of an image, form, or mold that replicates the patient's body or body segment, and, in turn, involves the rectification of dimensions, contours, and volumes to achieve proper fit, comfort, and function for that specific patient.

(17) "Temporary" means for a period of no more than six months with no repeats.

(18) "Short term" means designed or intended for a temporary, interim period of treatment, characterized usually by the early phase or initial treatment of disability, injury, or recovery, and generally fabricated of less-durable materials and does not apply to definitive orthoses or prostheses.

(19) "Long term" means designed or intended for use for the period of injury, disability, or recovery until the orthosis-prosthesis becomes unusable due to wear or patient body change.

(20) "Direct-formed" means a process of fabricating a device made of materials, usually of low-temperature moldability, so that it can be formed or shaped during the molding process directly on the patient's body or body segment without risk of injury to the patient's tissues.

(21) "Low temperature" means moldable or formable below one hundred sixty degrees Fahrenheit.

(22) "Prefabricated" means manufactured as a commercially available stock item for no specific patient. The fitting of prefabricated devices does not involve a separate interim process of generating an image form, or mold that replicates that specific patient's body or body segment and does not require the design and fabrication of the device from raw materials for that specific patient; the fitting of prefabricated devices involves only the adjustment or custom-fitting, to the extent possible, of commercially available off-the-shelf devices to treat patients' biomechanical and medical needs.

(23) "Authorized health care practitioner" means licensed physicians, osteopathic physicians, chiropractors, naturopaths, podiatric physicians and surgeons, and dentists. However, nothing in this section alters the scope of practice of these practitioners as defined in their licensure laws.

NEW SECTION. Sec. 3. Notwithstanding the provisions of chapter 18.130 RCW, a consultation and periodic review by an authorized health care practitioner is not required for evaluation, repair, adjusting, or servicing orthoses and prostheses by a licensed orthotist-prosthetist; nor is an authorized health care practitioner's order required for maintenance of an orthosis or prosthesis to the level of its original prescription for an indefinite period of time if the order remains appropriate for the patient's medical needs. However, an orthotist-prosthetist may only provide treatment utilizing new orthoses-prostheses for which the orthotist-prosthetist is licensed to do so and only under an order from or referral by an authorized health care practitioner.

NEW SECTION. Sec. 4. (1) Orthotists-prosthetists must refer persons under their care to authorized health care practitioners if they have reasonable cause to believe symptoms or conditions are present that require services beyond the scope of their practice or for which the prescribed orthotic-prosthetic treatment is contraindicated.

(2) A violation of this section is unprofessional conduct under this chapter and chapter 18.130 RCW.

NEW SECTION. Sec. 5. No person may practice or represent himself or herself as either an orthotist or prosthetist, or both, without a valid license.

NEW SECTION. Sec. 6. This chapter does not prevent or restrict the practice, services, or activities of:

(1) A person licensed in this state under any law from engaging in a profession or occupation for which the person is licensed;

(2) A person directly employed as an orthotist-prosthetist or orthotic-prosthetic assistant by the government of the United States, if the person provides either orthotic or prosthetic care, or both, solely under the direction or control of the organization by which the person is directly employed;

(3) A person pursuing a course of study leading to a degree or certificate in orthotics-prosthetics in an accredited or approved educational program if the activities and services constitute a part of a supervised course of study, if the person is designated by a title that clearly indicates the person's status as a student or trainee;

(4) A person fulfilling the supervised residency or internship experience requirements described in section 13 of this act, if the activities and services constitute a part of the experience necessary to meet the requirements of this chapter;

(5) A person performing orthotic-prosthetic services in this state if the services are performed for no more than ninety working days and if:

(a) The person is licensed under the laws of another state that has licensure requirements at least as stringent as the requirements of this chapter, as determined by the advisory committee; or

(b) The person has met commonly accepted standards for the practice of orthotics-prosthetics as specifically defined by the advisory committee;

(6) A person employed by or supervised by an orthotist-prosthetist as an orthotic-prosthetic assistant;

(7) A person with a limited permit. A limited permit may be granted to a person who has completed the educational and experience requirements of this chapter, or educational and experience requirements that the advisory committee deems equivalent to those specified as requirements for licensure. The limited permit allows the applicant to practice in association with an orthotist-prosthetist. The limited permit is valid until the results of the next examination have been made public. One extension of this permit may be granted if the applicant has failed the examination, but during this period the person must be under the direct supervision of an orthotist-prosthetist;

(8) A person who provides services that include designing, fabricating, or applying temporary orthoses designed strictly for short-term, temporary use or evaluation purposes, or a person providing the following assistive technology devices: Commercially available knee orthoses for use following injury or surgery; spastic muscle tone-inhibiting orthoses; face masks used following burns; upper extremity adaptive equipment; finger splints; hand splints; wheelchair seating that is an integral part of the wheelchair and not worn by the patient; fabric or elastic supports; corsets; arch supports; low temperature-formed plastic splints; trusses; elastic hose; canes; crutches; cervical collars; dental appliances; or other similar devices commonly carried in stock by a pharmacy, department store, corset shop, or surgical supply facility;

(9) A person providing, designing, fabricating, or applying temporary, nonalignable, nonarticulated, or nonweightbearing prostheses;

(10) A person providing, designing, fabricating, or applying temporary, nonalignable, or nonarticulated prostheses including upper limb prostheses intended to restore function for amputations distal to and including the carpals; or

(11) A person providing, designing, fabricating, or applying weightbearing lower limb prostheses for amputations distal to and including the transmetatarsal level.

NEW SECTION. Sec. 7. (1) There is established an orthotics and prosthetics advisory committee. The advisory committee consists of five members appointed by the governor. The governor may consider the persons who are recommended for appointment by the orthotic and prosthetic associations of the state. The members of the advisory committee must be residents of the state. Three of the members must have been engaged in rendering services to the public. One member must be a practicing orthotist. One member must be a practicing prosthetist. Two members must be members of the public, including consumers of orthotic and prosthetic professional services. One member must be licensed by the state as a doctor of medicine or doctor of osteopathy, specializing in orthopedic medicine or surgery or a podiatric physician or surgeon. Two of these five members must at all times be holders of licenses for the practice of either prosthetics or orthotics, or both, in this state, except for the initial members of the advisory committee, all of whom must fulfill the requirements for licensure under this chapter.

(2) The governor must, within sixty days after the effective date of this act, appoint one member for a term of one year, two members for a term of two years, and two members for a term of three years. Appointments made thereafter are for three-year terms, but no person may be appointed to serve more than two consecutive full terms. A term begins on the first day of the calendar year and ends on the last day of the calendar year or until a successor is appointed, except for the initial appointed members, who serve through the last calendar day of the year in which they are appointed before commencing the terms prescribed by this section. The governor must make an appointment for a vacancy in an unexpired term within ninety days after the vacancy occurred.

(3) The advisory committee must meet each January to select a chair and for other purposes. At least one additional meeting must be held before the end of each calendar year. Further meetings may be convened at the call of the chair or upon the written request of two advisory committee members. A majority of the members of the advisory committee constitutes a quorum for all purposes. All meetings of the advisory committee are open to the public, except that the advisory committee may hold closed sessions to prepare, approve, grade, or administer examinations, or, upon request of an applicant who fails an examination, to prepare a response indicating the reasons for the applicant's failure.

(4) Members of the advisory committee are compensated in the amount of fifty dollars for each day's attendance at proper meetings of the committee.

(5) A member may be removed from the advisory committee by the governor for:

(a) Loss of license as an orthotist, prosthetist, or orthotist-prosthetist;

(b) Loss of license as a doctor of medicine, doctor of osteopathy, or podiatric physician or surgeon;

(d) Having been found to be culpable for committing acts of moral turpitude, malfeasance in office, or criminal behavior.

NEW SECTION. Sec. 8. (1) The secretary must prescribe and publish fees in amounts determined by the secretary as provided in RCW 43.70.110 for the following purposes:

(a) Application for examination;

(b) Initial license fee;

(d) Late renewal fee; and

(e) Limited permit fee.

(2) The fees must be set in such an amount as to reimburse the state, to the extent feasible, for the cost of the services rendered.

NEW SECTION. Sec. 9. (1) The advisory committee administers, coordinates, and enforces this chapter, evaluates qualifications under this chapter, and provides for supervision of examinations of applicants for licensure under this chapter.

(2) The advisory committee is responsible for the licensure of orthotists, prosthetists, and orthotists-prosthetists, orthotic or prosthetic assistants, and persons eligible to be licensed in the disciplines of either orthotics or prosthetics, or both, as licensed orthotists, prosthetists, orthotists-prosthetists, or assistants.

(3) The advisory committee must review applications for licenses at least once a year. The advisory committee may collect license application fees, renewal fees, examination fees, and other administrative fees. The advisory committee must set the fees in amounts reasonable and necessary to carry out the program.

(4) The advisory committee must approve an examination required for a license under this chapter.

(5) The advisory committee may:

(a) Investigate complaints;

(b) Issue, renew, suspend, deny, and revoke licenses;

(d) Issue subpoenas;

(e) Hold hearings;

(f) Delegate authority for all or a portion of the activities in (a) through (e) of this subsection to a qualified contractor; and

(g) Determine fines.

(6) The advisory committee must maintain an information file about each complaint filed with the advisory committee. The advisory committee must also notify parties to the complaint quarterly as the status of the complaint unless this action would jeopardize an ongoing investigation.

(7) The advisory committee must assist legal authorities in the prosecution of a person violating this chapter.

(8) The advisory committee must prepare or approve continuing education programs for license holders and adopt rules requiring license holders to participate in the programs as a condition of renewing a license under this chapter.

(9) The advisory committee may make arrangements to accept practitioners who have been duly licensed by another state without further examination.

(10) The advisory committee may adopt rules as it deems necessary in the administration of this chapter.

NEW SECTION. Sec. 10. The secretary must provide administrative and investigative staff as are necessary for the advisory committee to carry out its duties under this chapter.

NEW SECTION. Sec. 11. The two members appointed to the advisory committee representing the public at large must have an interest in the rights of consumers of health services, and must not be or have been a member of another licensing committee, a licensee of a health occupation committee, an employee of a health facility, nor derive his or her primary livelihood from the provision of health services at any level of responsibility.

NEW SECTION. Sec. 12. The advisory committee may adopt rules in accordance with the administrative procedure act, chapter 34.05 RCW, relating to standards for appropriateness of orthotic-prosthetic care. A violation of the standards adopted by rule under this section is unprofessional conduct under this chapter and chapter 18.130 RCW.

NEW SECTION. Sec. 13. (1) An applicant applying for a license as an orthotist-prosthetist or as an orthotic-prosthetic assistant must file a written application on forms provided by the department showing to the satisfaction of the advisory committee that the applicant meets the following requirements:

(a) The applicant is of good moral character;

(b) The applicant possesses a baccalaureate degree from an accredited college or university;

(c) The applicant has the amount of formal training, including the hours of classroom education and clinical practice, in areas of study as the advisory committee deems necessary and appropriate;

(d) The applicant has completed a clinical internship or residency in the professional area for which a license is sought in accordance with the standards, guidelines, or procedures for clinical internships or residencies inside or outside the state established by the advisory committee; and

(e) An applicant for licensure as either an orthotist or prosthetist, or both, must:

(i) Pass all written, practical, and oral examinations that are required and approved by the advisory committee; or

(ii) Be qualified to practice in accordance with the American board for certification in orthotics and prosthetics.

(2) The standards and requirements for licensure established by the advisory committee must be substantially equal to or in excess of standards commonly accepted in the fields of orthotics and prosthetics.

(3) The advisory committee may adopt rules in accordance with the administrative procedure act, chapter 34.05 RCW, that are necessary to effectuate the requirements of this section.

(4) The advisory committee may waive the educational requirements specified under subsection (1)(b) of this section for an orthotic-prosthetic assistant who has met the experience and other requirements established by the advisory committee. Upon successful completion of the examination required of either the orthotist or the prosthetist, or both, the individual must be granted a license for that discipline.

NEW SECTION. Sec. 14. (1) A person applying for licensure must demonstrate eligibility in accordance with section 13 of this act and must apply for the examination upon a form and in a manner as the department prescribes. The application must be accompanied by the fee prescribed. The fee is nonrefundable. A person who fails an examination may apply for reexamination. The reapplication must be accompanied by the prescribed fee.

(2) An applicant for licensure under this chapter must be given a written examination to test the applicant's knowledge of the basic and clinical sciences relating to orthotics-prosthetics and orthotics-prosthetics theory and practice including the applicant's professional skills of orthotic-prosthetic techniques and methods, and other subjects as the advisory committee deems useful to determine the applicant's fitness to practice. The advisory committee approves the examination and establishes standards for acceptable performance.

(3) Applicants for licensure must be examined at a time and place and under such supervision as the advisory committee may determine. The examination must be given at least once each year at those places as the advisory committee determines, and the advisory committee must give reasonable public notice of the examinations in accordance with its rules at least sixty days prior to the administration of the examination.

(4) Applicants may obtain their examination scores and may review their papers in accordance with rules established by the advisory committee.

NEW SECTION. Sec. 15. (1) The advisory committee may waive the examination and grant a license to a person engaged in the profession of either an orthotist or prosthetist, or both, or either an orthotic or prosthetic assistant, or both, if the advisory committee determines that the person meets commonly accepted standards for the profession, as established by rule by the advisory committee. The advisory committee may waive the examination, education, or experience requirements and grant a license to a person meeting the standards adopted by the advisory committee under this section, if the advisory committee determines that the requirements for licensure in this chapter have been met.

(2) The advisory committee may grant a license to an applicant who presents proof of current licensure as either an orthotist or prosthetist, or both, or either an orthotic or prosthetic assistant, or both, in another state, the District of Columbia, or a territory of the United States, that requires standards for licensure considered by the advisory committee to be equivalent to the requirements for licensure under this chapter.

(3) The advisory committee must waive the education and experience requirements for licensure under section 13(1)(c) and (d) of this act for applicants for licensure who present evidence to the advisory committee that they have practiced full time for the past five years and have provided comprehensive orthotic-prosthetic, or orthotic and prosthetic care in an established orthotic and prosthetic facility for the five years immediately prior to the effective date of this act. The application must be filed with the advisory committee within one hundred eighty days of the effective date of this act in order to continue to practice either orthotics or prosthetics, or both, under the provisions of this chapter without taking an examination as required under this chapter. The applicant must pay all licensing fees required under this chapter. The advisory committee must complete an investigation into the applicant's work history. The investigation may include, but is not limited to, completion by the applicant of a questionnaire regarding his or her work history and scope of practice.

(4) For the purposes of this section, the advisory committee must complete its investigation of the applicant within one hundred eighty days of the date of the application.

NEW SECTION. Sec. 16. The secretary must issue a license to a person who meets the licensing requirements of this chapter upon payment of the prescribed license fee. The license must be posted in a conspicuous location at the person's work site.

NEW SECTION. Sec. 17. The secretary must furnish a license upon the authority of the advisory committee to a person who applies and is qualified under the provisions of this chapter. At the time of application the applicant must pay to the state treasurer a fee determined by the secretary as provided under section 8 of this act.

NEW SECTION. Sec. 18. (1) Licenses under this chapter must be renewed at the time and in the manner determined by the secretary and with the payment of a renewal fee. The advisory committee must establish requirements for license renewal that provide evidence of continued competency. The secretary may provide for the late renewal of a license upon the payment of a late fee, additional continuing education or examination requirements, or other requirements as determined by the advisory committee by rule.

(2) A suspended license is subject to expiration and may be renewed as provided in this section, but the renewal does not entitle the licensee, while the license remains suspended and until it is reinstated, to engage in the licensed activity, or in other conduct or activity in violation of the order or judgment by which the license was suspended. If a license that was revoked on disciplinary grounds is reinstated, the licensee, as a condition of reinstatement, must pay the renewal fee and an applicable late fee.

(3) Either an orthotist or a prosthetist, or both, and orthotic or prosthetic assistant, or both, licensed under this chapter not practicing orthotics-prosthetics or providing services may place his or her license on an inactive status. The secretary may set by rule requirements for maintaining an inactive status and converting from an inactive or active status.

NEW SECTION. Sec. 19. A person who is not licensed with the secretary as either an orthotist or a prosthetist, or both, under the requirements of this chapter must not represent him or herself as being so licensed and may not use in connection with his or her name the words or letters "L.O.," "L.P.," or "L.P.O.," or other letters, words, signs, numbers, or insignia indicating or implying that he or she is either an orthotist or a prosthetist, or both. No person may practice orthotics-prosthetics without first having a valid license. Nothing in this chapter prohibits a person licensed in this state under another law from engaging in the practice for which he or she is licensed. It is the duty of the prosecuting attorney of each county to prosecute all cases involving a violation of this chapter arising within his or her county. The attorney general may assist in the prosecution and must appear at all hearings when requested to do so by the advisory committee.

NEW SECTION. Sec. 20. If a person violates the provisions of this chapter, the attorney general, the prosecuting attorney, the secretary, the advisory committee, or a citizen of the same county, may maintain an action in the name of the state to enjoin a person from practicing or holding himself or herself out as practicing orthotics-prosthetics. The injunction does not relieve criminal prosecution but the remedy by injunction is in addition to the liability of the offender for criminal prosecution and the suspension or revocation of his or her license.

NEW SECTION. Sec. 21. The secretary must keep a record of proceedings under this chapter and a register of all persons licensed under it. The register must show the name of every living licensed orthotist or prosthetist, and his or her last known license as an orthotist or prosthetist.

NEW SECTION. Sec. 22. This chapter is known and may be cited as the orthotics-prosthetics practice act.

NEW SECTION. Sec. 23. The uniform disciplinary act, chapter 18.130 RCW, governs unlicensed practice, the issuance and denial of licenses, and the discipline of licensees under this chapter.

NEW SECTION. Sec. 24. Sections 2 through 23 of this act shall constitute a new chapter in Title 18 RCW.

NEW SECTION. Sec. 25. 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. 26. This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and shall take effect immediately.