BP BHEAD INT S [atlas:bill]

AN ACT Relating to the right of individuals to self-direct their own care in their own homes; amending RCW 18.88A.140, 18.64.255, 18.79.240, 18.79.260, 70.127.250, and 70.127.270; adding new sections to chapter 18.88A RCW; adding a new section to chapter 18.79 RCW; adding a new section to chapter 74.39 RCW; adding a new section to chapter 70.127 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 to reconfirm the right of competent individuals to self-direct their own care in their own homes.

NEW SECTION. Sec. 2. A new section is added to chapter 18.88A RCW to read as follows:

The nursing quality assurance commission in conjunction with the department of social and health services, the department of health, and other appropriate agencies shall, by December 1997, prepare a report to the legislature on possible remedies to the statutory inconsistencies contained in the October 1996 report to the legislature including issues relating to "assignment" of nursing care tasks.

NEW SECTION. Sec. 3. A new section is added to chapter 18.79 RCW to read as follows:

The department of health, in consultation with the nursing care quality assurance commission and appropriate advocates from the disability and aging communities, including the department of social and health services, shall adopt rules necessary to implement RCW 18.88A.140(4), 18.79.240(1)(s), and 18.64.255(4) to specifically address accountability and liability issues of health professionals involved in the delivery of health care to individuals described in those sections. The department of health shall also make recommendations to remove barriers from existing rules that would prohibit implementation of RCW 18.88A.140(4), 18.79.240(1)(s), and 18.64.255(4). The department of health has the authority to adopt such rules and shall do so by December 31, 1997.

NEW SECTION. Sec. 4. A new section is added to chapter 74.39 RCW to read as follows:

The department of social and health services, in consultation with interested parties and appropriate advocates from the disability and aging communities, including the department of health, has the authority to adopt necessary rules that address consent and determination of ability to self-direct and that remove restrictions in programs authorized under this chapter and chapter 74.39A RCW to allow self-directed care, and shall do so by December 31, 1997.

NEW SECTION. Sec. 5. A new section is added to chapter 18.88A RCW to read as follows:

The nursing care quality assurance commission shall convene a work group in conjunction with the department of health, the department of social and health services, and appropriate advocates from the aging and disability communities to propose rules necessary to implement RCW 18.88A.140(4). The department of health has the authority to adopt such rules and shall do so by December 31, 1997.

Sec. 6. RCW 18.88A.140 and 1991 c 16 s 5 are each amended to read as follows:

Nothing in this chapter may be construed to prohibit or restrict:

(1) The practice by an individual licensed, certified, or registered under the laws of this state and performing services within their authorized scope of practice;

(2) The practice by an individual employed by the government of the United States while engaged in the performance of duties prescribed by the laws of the United States;

(3) The practice by a person who is a regular student in an educational program approved by the secretary, and whose performance of services ((~~[is]~~)) is pursuant to a regular course of instruction or assignments from an instructor and under the general supervision of the instructor;

(4) The ability of an individual living in his or her own home who cannot physically self-administer care, but who can direct others to administer such care by informed consent or otherwise, including the administration of drugs or medications and other care, whether or not the care is administered for compensation.

Sec. 7. RCW 18.64.255 and 1995 c 319 s 7 are each amended to read as follows:

Nothing in this chapter shall operate in any manner:

(1) To restrict the scope of authorized practice of any practitioner other than a pharmacist, duly licensed as such under the laws of this state. However, a health care entity shall comply with all state and federal laws and rules relating to the dispensing of drugs and the practice of pharmacy; or

(2) In the absence of the pharmacist from the hospital pharmacy, to prohibit a registered nurse designated by the hospital and the responsible pharmacist from obtaining from the hospital pharmacy such drugs as are needed in an emergency: PROVIDED, That proper record is kept of such emergency, including the date, time, name of prescriber, the name of the nurse obtaining the drugs, and a list of what drugs and quantities of same were obtained; or

(3) To prevent shopkeepers, itinerant vendors, peddlers, or salesmen from dealing in and selling nonprescription drugs, if such drugs are sold in the original packages of the manufacturer, or in packages put up by a licensed pharmacist in the manner provided by the state board of pharmacy, if such shopkeeper, itinerant vendor, salesman, or peddler shall have obtained a registration; or

(4) To restrict the ability of an individual living in his or her own home who cannot physically self-administer medication, but who can direct others to administer such by informed consent or otherwise, whether or not the care is administered for compensation.

Sec. 8. RCW 18.79.240 and 1994 sp.s. c 9 s 424 are each amended to read as follows:

(1) In the context of the definition of registered nursing practice and advanced registered nursing practice, this chapter shall not be construed as:

(a) Prohibiting the incidental care of the sick by domestic servants or persons primarily employed as housekeepers, so long as they do not practice registered nursing within the meaning of this chapter;

(b) Preventing a person from the domestic administration of family remedies or the furnishing of nursing assistance in case of emergency;

(c) Prohibiting the practice of nursing by students enrolled in approved schools as may be incidental to their course of study or prohibiting the students from working as nursing aides;

(d) Prohibiting auxiliary services provided by persons carrying out duties necessary for the support of nursing services, including those duties that involve minor nursing services for persons performed in hospitals, nursing homes, or elsewhere under the direction of licensed physicians or the supervision of licensed registered nurses;

(e) Prohibiting the practice of nursing in this state by a legally qualified nurse of another state or territory whose engagement requires him or her to accompany and care for a patient temporarily residing in this state during the period of one such engagement, not to exceed six months in length, if the person does not represent or hold himself or herself out as a registered nurse licensed to practice in this state;

(f) Prohibiting nursing or care of the sick, with or without compensation, when done in connection with the practice of the religious tenets of a church by adherents of the church so long as they do not engage in the practice of nursing as defined in this chapter;

(g) Prohibiting the practice of a legally qualified nurse of another state who is employed by the United States government or a bureau, division, or agency thereof, while in the discharge of his or her official duties;

(h) Permitting the measurement of the powers or range of human vision, or the determination of the accommodation and refractive state of the human eye or the scope of its functions in general, or the fitting or adaptation of lenses for the aid thereof;

(i) Permitting the prescribing or directing the use of, or using, an optical device in connection with ocular exercises, visual training, vision training, or orthoptics;

(j) Permitting the prescribing of contact lenses for, or the fitting and adaptation of contact lenses to, the human eye;

(k) Prohibiting the performance of routine visual screening;

(l) Permitting the practice of dentistry or dental hygiene as defined in chapters 18.32 and 18.29 RCW, respectively;

(m) Permitting the practice of chiropractic as defined in chapter 18.25 RCW including the adjustment or manipulation of the articulation of the spine;

(n) Permitting the practice of podiatric medicine and surgery as defined in chapter 18.22 RCW;

(o) Permitting the performance of major surgery, except such minor surgery as the commission may have specifically authorized by rule adopted in accordance with chapter 34.05 RCW;

(p) Permitting the prescribing of controlled substances as defined in Schedules I through IV of the Uniform Controlled Substances Act, chapter 69.50 RCW, except as provided in (r) of this subsection;

(q) Prohibiting the determination and pronouncement of death;

(r) Prohibiting advanced registered nurse practitioners, approved by the commission as certified registered nurse anesthetists from selecting, ordering, or administering controlled substances as defined in Schedules II through IV of the Uniform Controlled Substances Act, chapter 69.50 RCW, consistent with their commission-recognized scope of practice; subject to facility-specific protocols, and subject to a request for certified registered nurse anesthetist anesthesia services issued by a physician licensed under chapter 18.71 RCW, an osteopathic physician and surgeon licensed under chapter 18.57 RCW, a dentist licensed under chapter 18.32 RCW, or a podiatric physician and surgeon licensed under chapter 18.22 RCW; the authority to select, order, or administer Schedule II through IV controlled substances being limited to those drugs that are to be directly administered to patients who require anesthesia for diagnostic, operative, obstetrical, or therapeutic procedures in a hospital, clinic, ambulatory surgical facility, or the office of a practitioner licensed under chapter 18.71, 18.22, 18.36, 18.36A, 18.57, 18.57A, or 18.32 RCW; "select" meaning the decision-making process of choosing a drug, dosage, route, and time of administration; and "order" meaning the process of directing licensed individuals pursuant to their statutory authority to directly administer a drug or to dispense, deliver, or distribute a drug for the purpose of direct administration to a patient, under instructions of the certified registered nurse anesthetist. "Protocol" means a statement regarding practice and documentation concerning such items as categories of patients, categories of medications, or categories of procedures rather than detailed case-specific formulas for the practice of nurse anesthesia;

(s) Prohibiting the administration of care to an individual living in his or her own home who cannot physically self-administer care, but who can direct others to administer such care by informed consent or otherwise, including the administration of drugs or medications and other care, whether or not the care is administered for compensation.

(2) In the context of the definition of licensed practical nursing practice, this chapter shall not be construed as:

(a) Prohibiting the incidental care of the sick by domestic servants or persons primarily employed as housekeepers, so long as they do not practice practical nursing within the meaning of this chapter;

(b) Preventing a person from the domestic administration of family remedies or the furnishing of nursing assistance in case of emergency;

(c) Prohibiting the practice of practical nursing by students enrolled in approved schools as may be incidental to their course of study or prohibiting the students from working as nursing assistants;

(e) Prohibiting or preventing the practice of nursing in this state by a legally qualified nurse of another state or territory whose engagement requires him or her to accompany and care for a patient temporarily residing in this state during the period of one such engagement, not to exceed six months in length, if the person does not represent or hold himself or herself out as a licensed practical nurse licensed to practice in this state;

(f) Prohibiting nursing or care of the sick, with or without compensation, when done in connection with the practice of the religious tenets of a church by adherents of the church so long as they do not engage in licensed practical nurse practice as defined in this chapter;

(g) Prohibiting the practice of a legally qualified nurse of another state who is employed by the United States government or any bureau, division, or agency thereof, while in the discharge of his or her official duties;

(h) Prohibiting the administration of care to an individual living in his or her own home who cannot physically self-administer care, but who can direct others to administer such care by informed consent or otherwise, including the administration of drugs or medications and other care, whether or not the care is administered for compensation.

Sec. 9. RCW 18.79.260 and 1995 1st sp.s. c 18 s 51 are each amended to read as follows:

A registered nurse under his or her license may perform for compensation nursing care, as that term is usually understood, of the ill, injured, or infirm, and in the course thereof, she or he may do the following things that shall not be done by a person not so licensed, except as provided in RCW 18.79.240, 18.79.270, and 18.88A.210:

(1) At or under the general direction of a licensed physician and surgeon, dentist, osteopathic physician and surgeon, naturopathic physician, podiatric physician and surgeon, physician assistant, osteopathic physician assistant, or advanced registered nurse practitioner acting within the scope of his or her license, administer medications, treatments, tests, and inoculations, whether or not the severing or penetrating of tissues is involved and whether or not a degree of independent judgment and skill is required. Such direction must be for acts which are within the scope of registered nursing practice;

(2) Delegate to other persons the functions outlined in subsection (1) of this section in accordance with chapter 18.88A RCW;

(3) Instruct nurses in technical subjects pertaining to nursing;

(4) Hold herself or himself out to the public or designate herself or himself as a registered nurse.

NEW SECTION. Sec. 10. A new section is added to chapter 70.127 RCW to read as follows:

Nothing in this chapter prohibits or restricts the administration of care to an individual living in his or her own home who cannot physically self-administer care, but who can direct others to administer such care by informed consent or otherwise, including the administration of drugs or medications and other nursing tasks, whether or not the care is administered for compensation.

Sec. 11. RCW 70.127.250 and 1994 sp.s. c 9 s 745 are each amended to read as follows:

(1) In addition to the rules consistent with RCW 70.127.005 adopted under RCW 70.127.120, the department shall adopt rules for home health agencies which address the following:

(a) Establishment of case management guidelines for acute and maintenance care patients;

(b) Establishment of guidelines for periodic review of the home health care plan of care and plan of treatment by appropriate health care professionals; ((~~and~~))

(c) Maintenance of written policies regarding the delivery and supervision of patient care and clinical consultation as necessary by appropriate health care professionals; and

(d) The administration of care to an individual living in his or her own home who cannot physically self-administer care, but who can direct others to administer such care by informed consent or otherwise, including the administration of drugs or medications and other care, whether or not the care is administered for compensation.

(2) As used in this section:

(a) "Acute care" means care provided by a home health agency for patients who are not medically stable or have not attained a satisfactory level of rehabilitation. These patients require frequent monitoring by a health care professional in order to maintain their health status.

(b) "Maintenance care" means care provided by home health agencies that is necessary to support an existing level of health and to preserve a patient from further failure or decline.

(c) "Home health plan of care" means a written plan of care established by a home health agency by appropriate health care professionals that describes maintenance care to be provided. A patient or his or her representative shall be allowed to participate in the development of the plan of care to the extent practicable.

(d) "Home health plan of treatment" means a written plan of care established by a physician licensed under chapter 18.57 or 18.71 RCW, a podiatric physician and surgeon licensed under chapter 18.22 RCW, or an advanced registered nurse practitioner as authorized by the nursing care quality assurance commission under chapter 18.79 RCW, in consultation with appropriate health care professionals within the agency that describes medically necessary acute care to be provided for treatment of illness or injury.

Sec. 12. RCW 70.127.270 and 1988 c 245 s 28 are each amended to read as follows:

In addition to the rules adopted under RCW 70.127.120, the department shall adopt rules consistent with RCW 70.127.005 for home care agencies which address delivery of services according to a home care plan of care, including the administration of care to an individual living in his or her own home who cannot physically self-administer care, but who can direct others to administer such care by informed consent or otherwise, including the administration of drugs or medications and other care, whether or not the care is administered for compensation.

As used in this section, "home care plan of care" means a written plan of care that is established and periodically reviewed by a home care agency that describes the home care to be provided.

NEW SECTION. Sec. 13. 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 takes effect immediately.