BILL REQ. #:  H-0306.1 

Read first time 01/13/2005.   Referred to Committee on Health Care.

     AN ACT Relating to the uniform disciplinary act for health professions; amending RCW 18.130.160 and 18.130.172; adding a new section to chapter 18.130 RCW; and creating new sections.

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

NEW SECTION.  Sec. 1   The uniform disciplinary act provides a consistent process for addressing acts of unprofessional conduct affecting fifty-nine health professions regulated by the state. The disciplinary authorities include the secretary of health and sixteen boards and commissions charged with protecting the health and safety of patients from unprofessional conduct. It is recognized nationally as a model law and has worked well over time to provide uniformity and efficiency to the disciplinary process.
     The legislature finds that there may be methods for increasing the efficiency and effectiveness of this model through the redistribution of duties between the secretary of health and the health profession boards and commissions. In addition, there is an opportunity to achieve greater consistency in the sanctions imposed across the health professions through specifically identified sanctions for specific acts of unprofessional conduct. A more consistent application of sanctions across professions protects both the safety of the public and the due process rights of all health care professionals.

NEW SECTION.  Sec. 2   The secretary of health shall establish a work group to review the complaint processing and sanction determination phases of the health professions disciplinary process. At the secretary of health's discretion, the work group may include representatives of different health profession boards and commissions, professional associations, and other interested parties. The work group shall submit a report to the legislature by December 1, 2005, with recommendations for creating:
     (1) Greater efficiencies between the health professions boards and commissions and the secretary of health in processing complaints against license holders; and
     (2) More consistent sanction determinations that balance the protection of the public's health and the rights of health care providers among the different health professions, including recommendations for specific ranges of sanctions for each act of unprofessional conduct and the effect of any aggravating and mitigating factors that may apply to each.

Sec. 3   RCW 18.130.160 and 2001 c 195 s 1 are each amended to read as follows:
     Upon a finding, after hearing, that a license holder or applicant has committed unprofessional conduct or is unable to practice with reasonable skill and safety due to a physical or mental condition, the disciplining authority may issue an order providing for one or any combination of the following:
     (1) Revocation of the license;
     (2) Suspension of the license for a fixed or indefinite term;
     (3) Restriction or limitation of the practice;
     (4) Requiring the satisfactory completion of a specific program of remedial education or treatment;
     (5) The monitoring of the practice by a supervisor approved by the disciplining authority;
     (6) Censure or reprimand;
     (7) Compliance with conditions of probation for a designated period of time;
     (8) Payment of a fine for each violation of this chapter, not to exceed five thousand dollars per violation. Funds received shall be placed in the health professions account;
     (9) Denial of the license request;
     (10) Corrective action;
     (11) Refund of fees billed to and collected from the consumer;
     (12) A surrender of the practitioner's license in lieu of other sanctions, which must be reported to the federal data bank.
     Except as otherwise provided in section 5 of this act, any of the actions under this section may be totally or partly stayed by the disciplining authority. In determining what action is appropriate, the disciplining authority must first consider what sanctions are necessary to protect or compensate the public. Only after such provisions have been made may the disciplining authority consider and include in the order requirements designed to rehabilitate the license holder or applicant. All costs associated with compliance with orders issued under this section are the obligation of the license holder or applicant.
     The licensee or applicant may enter into a stipulated disposition of charges that includes one or more of the sanctions of this section, but only after a statement of charges has been issued and the licensee has been afforded the opportunity for a hearing and has elected on the record to forego such a hearing. The stipulation shall either contain one or more specific findings of unprofessional conduct or inability to practice, or a statement by the licensee acknowledging that evidence is sufficient to justify one or more specified findings of unprofessional conduct or inability to practice. The stipulation entered into pursuant to this subsection shall be considered formal disciplinary action for all purposes.

Sec. 4   RCW 18.130.172 and 2000 c 171 s 29 are each amended to read as follows:
     (1) Except for those acts of unprofessional conduct specified in section 5 of this act, prior to serving a statement of charges under RCW 18.130.090 or 18.130.170, the disciplinary authority may furnish a statement of allegations to the licensee or applicant along with a detailed summary of the evidence relied upon to establish the allegations and a proposed stipulation for informal resolution of the allegations. These documents shall be exempt from public disclosure until such time as the allegations are resolved either by stipulation or otherwise.
     (2) The disciplinary authority and the applicant or licensee may stipulate that the allegations may be disposed of informally in accordance with this subsection. The stipulation shall contain a statement of the facts leading to the filing of the complaint; the act or acts of unprofessional conduct alleged to have been committed or the alleged basis for determining that the applicant or licensee is unable to practice with reasonable skill and safety; a statement that the stipulation is not to be construed as a finding of either unprofessional conduct or inability to practice; an acknowledgement that a finding of unprofessional conduct or inability to practice, if proven, constitutes grounds for discipline under this chapter; and an agreement on the part of the licensee or applicant that the sanctions set forth in RCW 18.130.160, except RCW 18.130.160 (1), (2), (6), and (8), may be imposed as part of the stipulation, except that no fine may be imposed but the licensee or applicant may agree to reimburse the disciplinary authority the costs of investigation and processing the complaint up to an amount not exceeding one thousand dollars per allegation; and an agreement on the part of the disciplinary authority to forego further disciplinary proceedings concerning the allegations. A stipulation entered into pursuant to this subsection shall not be considered formal disciplinary action.
     (3) If the licensee or applicant declines to agree to disposition of the charges by means of a stipulation pursuant to subsection (2) of this section, the disciplinary authority may proceed to formal disciplinary action pursuant to RCW 18.130.090 or 18.130.170.
     (4) Upon execution of a stipulation under subsection (2) of this section by both the licensee or applicant and the disciplinary authority, the complaint is deemed disposed of and shall become subject to public disclosure on the same basis and to the same extent as other records of the disciplinary authority. Should the licensee or applicant fail to pay any agreed reimbursement within thirty days of the date specified in the stipulation for payment, the disciplinary authority may seek collection of the amount agreed to be paid in the same manner as enforcement of a fine under RCW 18.130.165.

NEW SECTION.  Sec. 5   A new section is added to chapter 18.130 RCW to read as follows:
     (1) The disciplining authority shall revoke the license of a license holder who is found to have committed three acts of unprofessional conduct from the following list in any combination within a ten-year period:
     (a) Any act defined in RCW 18.130.180(4) that causes or substantially contributes to the death of or severe injury to a patient or creates a significant risk of harm to the public;
     (b) Any act defined in RCW 18.130.180(6);
     (c) Any act defined in RCW 18.130.180(7) that causes or substantially contributes to the death of or severe injury to a patient or creates a significant risk of harm to the public;
     (d) Any act defined in RCW 18.130.180(17);
     (e) Any act defined in RCW 18.130.180(23) that causes or substantially contributes to the death of or severe injury to a patient or creates a significant risk of harm to the public;
     (f) Any act of abuse to a client or patient as defined in RCW 18.130.180(24); and
     (g) Any sexual contact with a client or patient as defined in RCW 18.130.180(24).
     (2) For purposes of determining whether a license holder is found to have committed three acts of unprofessional conduct for purposes of this section:
     (a) Under subsection (1)(g) of this section, one or more acts with one patient or client that are charged as part of one statement of charges shall be considered one act of unprofessional conduct; and
     (b) Under subsection (1)(a) through (f) of this section, each incident of unprofessional conduct shall be considered one act of unprofessional conduct.
     (3) A finding of mitigating circumstances for an act of unprofessional conduct may be issued and, except for (a) of this subsection, applied one time for any license holder or applicant for a license, and if so, that finding of unprofessional conduct does not count as one of the three findings that triggers a license revocation for purposes of this section. A finding of mitigating circumstances under (a) of this subsection may be issued and applied as many times as the license holder meets the criteria for such a finding and does not count as one of the three findings that triggers the revocation of a license for the purposes of this section. Except for (a) of this subsection, after a finding of mitigating circumstances is issued and applied, no subsequent findings under this section may consider any mitigating circumstances. The following mitigating circumstances may be considered:
     (a) For subsection (1)(a) of this section, the act involved a high-risk procedure, there was no lower-risk alternative to that procedure, the patient was informed of the risks of the procedure and consented to the procedure anyway, and prior to the institution of disciplinary actions the license holder took appropriate remedial measures;
     (b) There is a strong potential for rehabilitation of the license holder; or
     (c) There is a strong potential for remedial education and training to prevent future harm to the public.
     (4) Nothing in this section limits the authority of the disciplining authority to revoke a license or take other disciplinary action when the license holder has committed only one or two acts of unprofessional conduct instead of three.