1642-SAMSHEAS2881.1SHB 1642S COMM AMDBy Committee on Health & Long-Term Care Strike everything after the enacting clause and insert thefollowing:Sec. RCW 4.24.250 and 1981 c 181 s 1 are each amended to readas follows: (1) Any health care provider as defined in RCW 7.70.020 (1) and (2)as now existing or hereafter amended who, in good faith, files chargesor presents evidence against another member of their profession basedon the claimed incompetency or gross misconduct of such person beforea regularly constituted review committee or board of a professionalsociety or hospital whose duty it is to evaluate the competency andqualifications of members of the profession, including limiting theextent of practice of such person in a hospital or similar institution,or before a regularly constituted committee or board of a hospitalwhose duty it is to review and evaluate the quality of patient care,shall be immune from civil action for damages arising out of suchactivities. The proceedings, reports, and written records of suchcommittees or boards, or of a member, employee, staff person, orinvestigator of such a committee or board, shall not be subject tosubpoena or discovery proceedings in any civil action, except actionsarising out of the recommendations of such committees or boardsinvolving the restriction or revocation of the clinical or staffprivileges of a health care provider as defined above. (2) A coordinated quality improvement program maintained inaccordance with RCW 43.70.510 or 70.41.200 may share information anddocuments, including complaints and incident reports, createdspecifically for, and collected and maintained by a coordinated qualityimprovement committee or committees or boards under subsection (1) ofthis section, with one or more other coordinated quality improvementprograms for the improvement of the quality of health care servicesrendered to patients and the identification and prevention of medical 1 malpractice. Information and documents disclosed by one coordinatedquality improvement program to another coordinated quality improvementprogram and any information and documents created or maintained as aresult of the sharing of information and documents shall not be subjectto the discovery process and confidentiality shall be respected asrequired by subsection (1) of this section and by RCW 43.70.510(4) and70.41.200(3).Sec. RCW 43.70.510 and 1995 c 267 s 7 are each amended to readas follows: (1)(a) Health care institutions and medical facilities, other thanhospitals, that are licensed by the department, professional societiesor organizations, health care service contractors, health maintenanceorganizations, health carriers approved pursuant to chapter 48.43 RCW,and any other person or entity providing health care coverage underchapter 48.42 RCW that is subject to the jurisdiction and regulation ofany state agency or any subdivision thereof may maintain a coordinatedquality improvement program for the improvement of the quality ofhealth care services rendered to patients and the identification andprevention of medical malpractice as set forth in RCW 70.41.200. (b) All such programs shall comply with the requirements of RCW70.41.200(1)(a), (c), (d), (e), (f), (g), and (h) as modified toreflect the structural organization of the institution, facility,professional societies or organizations, health care servicecontractors, health maintenance organizations, health carriers, or anyother person or entity providing health care coverage under chapter48.42 RCW that is subject to the jurisdiction and regulation of anystate agency or any subdivision thereof, unless an alternative qualityimprovement program substantially equivalent to RCW 70.41.200(1)(a) isdeveloped. All such programs, whether complying with the requirementset forth in RCW 70.41.200(1)(a) or in the form of an alternativeprogram, must be approved by the department before the discoverylimitations provided in subsections (3) and (4) of this section and theexemption under RCW 42.17.310(1)(hh) and subsection (5) of this sectionshall apply. In reviewing plans submitted by licensed entities thatare associated with physicians' offices, the department shall ensurethat the exemption under RCW 42.17.310(1)(hh) and the discovery 2 limitations of this section are applied only to information anddocuments related specifically to quality improvement activitiesundertaken by the licensed entity. (2) Health care provider groups of ((ten)) five or more providersmay maintain a coordinated quality improvement program for theimprovement of the quality of health care services rendered to patientsand the identification and prevention of medical malpractice as setforth in RCW 70.41.200. All such programs shall comply with therequirements of RCW 70.41.200(1)(a), (c), (d), (e), (f), (g), and (h)as modified to reflect the structural organization of the health careprovider group. All such programs must be approved by the departmentbefore the discovery limitations provided in subsections (3) and (4) ofthis section and the exemption under RCW 42.17.310(1)(hh) andsubsection (5) of this section shall apply. (3) Any person who, in substantial good faith, provides informationto further the purposes of the quality improvement and medicalmalpractice prevention program or who, in substantial good faith,participates on the quality improvement committee shall not be subjectto an action for civil damages or other relief as a result of suchactivity. (4) Information and documents, including complaints and incidentreports, created specifically for, and collected, and maintained by aquality improvement committee are not subject to discovery orintroduction into evidence in any civil action, and no person who wasin attendance at a meeting of such committee or who participated in thecreation, collection, or maintenance of information or documentsspecifically for the committee shall be permitted or required totestify in any civil action as to the content of such proceedings orthe documents and information prepared specifically for the committee.This subsection does not preclude: (a) In any civil action, thediscovery of the identity of persons involved in the medical care thatis the basis of the civil action whose involvement was independent ofany quality improvement activity; (b) in any civil action, thetestimony of any person concerning the facts that form the basis forthe institution of such proceedings of which the person had personalknowledge acquired independently of such proceedings; (c) in any civilaction by a health care provider regarding the restriction or 3 revocation of that individual's clinical or staff privileges,introduction into evidence information collected and maintained byquality improvement committees regarding such health care provider; (d)in any civil action challenging the termination of a contract by astate agency with any entity maintaining a coordinated qualityimprovement program under this section if the termination was on thebasis of quality of care concerns, introduction into evidence ofinformation created, collected, or maintained by the qualityimprovement committees of the subject entity, which may be under termsof a protective order as specified by the court; (e) in any civilaction, disclosure of the fact that staff privileges were terminated orrestricted, including the specific restrictions imposed, if any and thereasons for the restrictions; or (f) in any civil action, discovery andintroduction into evidence of the patient's medical records required byrule of the department of health to be made regarding the care andtreatment received. (5) Information and documents created specifically for, andcollected and maintained by a quality improvement committee are exemptfrom disclosure under chapter 42.17 RCW. (6) A coordinated quality improvement program may share informationand documents, including complaints and incident reports, createdspecifically for, and collected and maintained by a quality improvementcommittee or a peer review committee under RCW 4.24.250 with one ormore other coordinated quality improvement programs maintained inaccordance with this section or with RCW 70.41.200, for the improvementof the quality of health care services rendered to patients and theidentification and prevention of medical malpractice. Information anddocuments disclosed by one coordinated quality improvement program toanother coordinated quality improvement program and any information anddocuments created or maintained as a result of the sharing ofinformation and documents shall not be subject to the discovery processand confidentiality shall be respected as required by subsection (4) ofthis section and RCW 4.24.250. (7) The department of health shall adopt rules as are necessary toimplement this section. 4 Sec. RCW 70.41.200 and 2000 c 6 s 3 are each amended to read asfollows: (1) Every hospital shall maintain a coordinated quality improvementprogram for the improvement of the quality of health care servicesrendered to patients and the identification and prevention of medicalmalpractice. The program shall include at least the following: (a) The establishment of a quality improvement committee with theresponsibility to review the services rendered in the hospital, bothretrospectively and prospectively, in order to improve the quality ofmedical care of patients and to prevent medical malpractice. Thecommittee shall oversee and coordinate the quality improvement andmedical malpractice prevention program and shall ensure thatinformation gathered pursuant to the program is used to review and torevise hospital policies and procedures; (b) A medical staff privileges sanction procedure through whichcredentials, physical and mental capacity, and competence in deliveringhealth care services are periodically reviewed as part of an evaluationof staff privileges; (c) The periodic review of the credentials, physical and mentalcapacity, and competence in delivering health care services of allpersons who are employed or associated with the hospital; (d) A procedure for the prompt resolution of grievances by patientsor their representatives related to accidents, injuries, treatment, andother events that may result in claims of medical malpractice; (e) The maintenance and continuous collection of informationconcerning the hospital's experience with negative health care outcomesand incidents injurious to patients, patient grievances, professionalliability premiums, settlements, awards, costs incurred by the hospitalfor patient injury prevention, and safety improvement activities; (f) The maintenance of relevant and appropriate informationgathered pursuant to (a) through (e) of this subsection concerningindividual physicians within the physician's personnel or credentialfile maintained by the hospital; (g) Education programs dealing with quality improvement, patientsafety, medication errors, injury prevention, staff responsibility toreport professional misconduct, the legal aspects of patient care, 5 improved communication with patients, and causes of malpractice claimsfor staff personnel engaged in patient care activities; and (h) Policies to ensure compliance with the reporting requirementsof this section. (2) Any person who, in substantial good faith, provides informationto further the purposes of the quality improvement and medicalmalpractice prevention program or who, in substantial good faith,participates on the quality improvement committee shall not be subjectto an action for civil damages or other relief as a result of suchactivity. (3) Information and documents, including complaints and incidentreports, created specifically for, and collected, and maintained by aquality improvement committee are not subject to discovery orintroduction into evidence in any civil action, and no person who wasin attendance at a meeting of such committee or who participated in thecreation, collection, or maintenance of information or documentsspecifically for the committee shall be permitted or required totestify in any civil action as to the content of such proceedings orthe documents and information prepared specifically for the committee.This subsection does not preclude: (a) In any civil action, thediscovery of the identity of persons involved in the medical care thatis the basis of the civil action whose involvement was independent ofany quality improvement activity; (b) in any civil action, thetestimony of any person concerning the facts which form the basis forthe institution of such proceedings of which the person had personalknowledge acquired independently of such proceedings; (c) in any civilaction by a health care provider regarding the restriction orrevocation of that individual's clinical or staff privileges,introduction into evidence information collected and maintained byquality improvement committees regarding such health care provider; (d)in any civil action, disclosure of the fact that staff privileges wereterminated or restricted, including the specific restrictions imposed,if any and the reasons for the restrictions; or (e) in any civilaction, discovery and introduction into evidence of the patient'smedical records required by regulation of the department of health tobe made regarding the care and treatment received. 6 (4) Each quality improvement committee shall, on at least asemiannual basis, report to the governing board of the hospital inwhich the committee is located. The report shall review the qualityimprovement activities conducted by the committee, and any actionstaken as a result of those activities. (5) The department of health shall adopt such rules as are deemedappropriate to effectuate the purposes of this section. (6) The medical quality assurance commission or the board ofosteopathic medicine and surgery, as appropriate, may review and auditthe records of committee decisions in which a physician's privilegesare terminated or restricted. Each hospital shall produce and makeaccessible to the commission or board the appropriate records andotherwise facilitate the review and audit. Information so gained shallnot be subject to the discovery process and confidentiality shall berespected as required by subsection (3) of this section. Failure of ahospital to comply with this subsection is punishable by a civilpenalty not to exceed two hundred fifty dollars. (7) The department, the joint commission on accreditation of healthcare organizations, and any other accrediting organization may reviewand audit the records of a quality improvement committee or peer reviewcommittee in connection with their inspection and review of hospitals.Information so obtained shall not be subject to the discovery process,and confidentiality shall be respected as required by subsection (3) ofthis section. Each hospital shall produce and make accessible to thedepartment the appropriate records and otherwise facilitate the reviewand audit. (8) A coordinated quality improvement program may share informationand documents, including complaints and incident reports, createdspecifically for, and collected and maintained by a quality improvementcommittee or a peer review committee under RCW 4.24.250 with one ormore other coordinated quality improvement programs maintained inaccordance with this section or with RCW 43.70.510, for the improvementof the quality of health care services rendered to patients and theidentification and prevention of medical malpractice. Information anddocuments disclosed by one coordinated quality improvement program toanother coordinated quality improvement program and any information anddocuments created or maintained as a result of the sharing of 7 information and documents shall not be subject to the discovery processand confidentiality shall be respected as required by subsection (3) ofthis section and RCW 4.24.250. (9) Violation of this section shall not be considered negligenceper se.SHB 1642S COMM AMDBy Committee on Health & Long-Term Care On page 1, line 2 of the title, after programs; strike theremainder of the title and insert and amending RCW 4.24.250,43.70.510, and 70.41.200.--- END --- 8