BILL REQ. #: S-0734.1
| State of Washington | 59th Legislature | 2005 Regular Session |
Read first time 01/20/2005. Referred to Committee on Health & Long-Term Care.
AN ACT Relating to improving health care professional and health care facility patient safety practices; amending RCW 43.70.110, 43.70.250, and 5.64.010; adding new sections to chapter 43.70 RCW; adding a new section to chapter 7.70 RCW; creating new sections; providing an effective date; and declaring an emergency.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
NEW SECTION. Sec. 1 (1) The legislature finds that:
(a) Thousands of patients are injured each year in the United
States as a result of medical errors, and that a comprehensive approach
is needed to effectively reduce the incidence of medical errors in our
health care system. Implementation of proven patient safety strategies
can reduce medical errors, and thereby potentially reduce the need for
disciplinary actions against licensed health care professionals and
facilities, and the frequency and severity of medical malpractice
claims; and
(b) Health care providers, health care facilities, and health
carriers can and should be supported in their efforts to improve
patient safety and reduce medical errors by encouraging health care
facilities and providers to communicate openly with patients regarding
medical errors that have occurred and steps that can be taken to
prevent errors from occurring in the future, encouraging health care
facilities and providers to work cooperatively in their patient safety
efforts, and increasing funding available to implement proven patient
safety strategies.
(2) Through the adoption of this act, the legislature intends to
positively influence the safety and quality of care provided in
Washington state's health care system.
Sec. 101 RCW 43.70.110 and 1993 sp.s. c 24 s 918 are each amended
to read as follows:
(1) The secretary shall charge fees to the licensee for obtaining
a license. After June 30, 1995, municipal corporations providing
emergency medical care and transportation services pursuant to chapter
18.73 RCW shall be exempt from such fees, provided that such other
emergency services shall only be charged for their pro rata share of
the cost of licensure and inspection, if appropriate. The secretary
may waive the fees when, in the discretion of the secretary, the fees
would not be in the best interest of public health and safety, or when
the fees would be to the financial disadvantage of the state.
(2) Except as provided in section 103 of this act, fees charged
shall be based on, but shall not exceed, the cost to the department for
the licensure of the activity or class of activities and may include
costs of necessary inspection.
(3) Department of health advisory committees may review fees
established by the secretary for licenses and comment upon the
appropriateness of the level of such fees.
Sec. 102 RCW 43.70.250 and 1996 c 191 s 1 are each amended to
read as follows:
It shall be the policy of the state of Washington that the cost of
each professional, occupational, or business licensing program be fully
borne by the members of that profession, occupation, or business. The
secretary shall from time to time establish the amount of all
application fees, license fees, registration fees, examination fees,
permit fees, renewal fees, and any other fee associated with licensing
or regulation of professions, occupations, or businesses administered
by the department. In fixing said fees, the secretary shall set the
fees for each program at a sufficient level to defray the costs of
administering that program and the patient safety fee established in
section 103 of this act. All such fees shall be fixed by rule adopted
by the secretary in accordance with the provisions of the
administrative procedure act, chapter 34.05 RCW.
NEW SECTION. Sec. 103 A new section is added to chapter 43.70
RCW to read as follows:
(1) The secretary shall increase the licensing fee established
under RCW 43.70.110 by two dollars for the health care professionals
designated in subsection (2) of this section and by two dollars per
licensed bed for the health care facilities designated in subsection
(2) of this section. Proceeds of the patient safety fee must be
deposited into the patient safety account in section 107 of this act
and dedicated to patient safety and medical error reduction efforts
that have been proven to improve, or have a substantial likelihood of
improving the quality of care provided by health care professionals and
facilities.
(2) The health care professionals and facilities subject to the
patient safety fee are:
(a) The following health care professionals licensed under Title 18
RCW:
(i) Registered nurses and licensed practical nurses licensed under
chapter 18.79 RCW;
(ii) Chiropractors licensed under chapter 18.25 RCW;
(iii) Dentists licensed under chapter 18.32 RCW;
(iv) Midwives licensed under chapter 18.50 RCW;
(v) Naturopaths licensed under chapter 18.36A RCW;
(vi) Nursing home administrators licensed under chapter 18.52 RCW;
(vii) Optometrists licensed under chapter 18.53 RCW;
(viii) Osteopathic physicians licensed under chapter 18.57 RCW;
(ix) Osteopathic physicians' assistants licensed under chapter
18.57A RCW;
(x) Pharmacists and pharmacies licensed under chapter 18.64 RCW;
(xi) Physicians licensed under chapter 18.71 RCW;
(xii) Physician assistants licensed under chapter 18.71A RCW;
(xiii) Podiatrists licensed under chapter 18.22 RCW; and
(xiv) Psychologists licensed under chapter 18.83 RCW; and
(b) Hospitals licensed under chapter 70.41 RCW and psychiatric
hospitals licensed under chapter 71.12 RCW.
NEW SECTION. Sec. 104 A new section is added to chapter 7.70 RCW
to read as follows:
(1)(a) One percent of any attorney contingency fee as contracted
with a prevailing plaintiff in any action for damages based upon
injuries resulting from health care shall be deducted from the
contingency fee as a patient safety set aside. Proceeds of the patient
safety set aside will be distributed by the department of health in the
form of grants, loans, or other appropriate arrangements to support
strategies that have been proven to reduce medical errors and enhance
patient safety, or have a substantial likelihood of reducing medical
errors and enhancing patient safety, as provided in section 103 of this
act.
(b) A patient safety set aside shall be transmitted to the
secretary of the department of health by the person or entity paying
the claim, settlement, or verdict for deposit into the patient safety
account established in section 107 of this act.
(c) The supreme court shall by rule adopt procedures to implement
this section.
(2) If the patient safety set aside established by this section is
invalidated by the Washington state supreme court, then any attorney
representing a claimant who receives a settlement or verdict in any
action for damages based upon injuries resulting from health care under
this chapter shall provide information to the claimant regarding the
existence and purpose of the patient safety account and notify the
claimant that he or she may make a contribution to that account under
section 106 of this act.
NEW SECTION. Sec. 105 A new section is added to chapter 43.70
RCW to read as follows:
(1)(a) Patient safety fee and set aside proceeds shall be
administered by the department, after seeking input from health care
providers engaged in direct patient care activities, health care
facilities, health care provider organizations, and other interested
parties. In developing criteria for the award of grants, loans, or
other appropriate arrangements under this section, the department shall
rely primarily upon evidence-based practices to improve patient safety
that have been identified and recommended by governmental and private
organizations, including, but not limited to:
(i) The federal agency for health care quality and research;
(ii) The institute of medicine of the national academy of sciences;
(iii) The joint commission on accreditation of health care
organizations; and
(iv) The national quality forum.
(b) The department shall award grants, loans, or other appropriate
arrangements for at least two strategies that are designed to meet the
goals and recommendations of the federal institute of medicine's
report, "Keeping Patients Safe: Transforming the Work Environment of
Nurses."
(2) Projects that have been proven to reduce medical errors and
enhance patient safety shall receive priority for funding over those
that are not proven, but have a substantial likelihood of reducing
medical errors and enhancing patient safety. All project proposals
must include specific performance and outcome measures by which to
evaluate the effectiveness of the project. Project proposals that do
not propose to use a proven patient safety strategy must include, in
addition to performance and outcome measures, a detailed description of
the anticipated outcomes of the project based upon any available
related research and the steps for achieving those outcomes.
(3) The department may use a portion of the patient safety fee
proceeds for the costs of administering the program.
NEW SECTION. Sec. 106 A new section is added to chapter 43.70
RCW to read as follows:
The secretary may solicit and accept grants or other funds from
public and private sources to support patient safety and medical error
reduction efforts under this act. Any grants or funds received may be
used to enhance these activities as long as program standards
established by the secretary are followed.
NEW SECTION. Sec. 107 A new section is added to chapter 43.70
RCW to read as follows:
The patient safety account is created in the state treasury. All
receipts from the fees and set asides created in sections 103 and 104
of this act must be deposited into the account. Expenditures from the
account may be used only for the purposes of this act. Moneys in the
account may be spent only after appropriation.
NEW SECTION. Sec. 108 A new section is added to chapter 43.70
RCW to read as follows:
By December 1, 2008, the department shall report the following
information to the governor and the health policy and fiscal committees
of the legislature:
(1) The amount of patient safety fees and set asides deposited to
date in the patient safety account;
(2) The criteria for distribution of grants, loans, or other
appropriate arrangements under this act; and
(3) A description of the medical error reduction and patient safety
grants and loans distributed to date, including the stated performance
measures, activities, timelines, and detailed information regarding
outcomes for each project.
Sec. 201 RCW 5.64.010 and 1975-'76 2nd ex.s. c 56 s 3 are each
amended to read as follows:
(1) In any civil action against a health care provider for personal
injuries which is based upon alleged professional negligence ((and
which is against:)), or in any arbitration or mediation proceeding
related to such civil action, evidence of furnishing or offering or
promising to pay medical, hospital, or similar expenses occasioned by
an injury is not admissible to prove liability for the injury.
(1) A person licensed by this state to provide health care or
related services, including, but not limited to, a physician,
osteopathic physician, dentist, nurse, optometrist, podiatrist,
chiropractor, physical therapist, psychologist, pharmacist, optician,
physician's assistant, osteopathic physician's assistant, nurse
practitioner, or physician's trained mobile intensive care paramedic,
including, in the event such person is deceased, his estate or personal
representative;
(2) An employee or agent of a person described in subsection (1) of
this section, acting in the course and scope of his employment,
including, in the event such employee or agent is deceased, his estate
or personal representative; or
(3) An entity, whether or not incorporated, facility, or
institution employing one or more persons described in subsection (1)
of this section, including, but not limited to, a hospital, clinic,
health maintenance organization, or nursing home; or an officer,
director, employee, or agent thereof acting in the course and scope of
his employment, including, in the event such officer, director,
employee, or agent is deceased, his estate or personal
representative;
(2) In a civil action against a health care provider for personal
injuries which is based upon alleged professional negligence, or in any
arbitration or mediation proceeding related to such civil action:
(a) Any and all statements, affirmations, gestures, or conduct
expressing apology, fault, sympathy, commiseration, condolence,
compassion, or a general sense of benevolence; or
(b) Any and all statements or affirmations regarding remedial
actions that may be taken to address the act or omission that is the
basis for the allegation of negligence;
which were in the past or are made by a health care provider to the
injured person, a relative of the injured person, or a representative
of the injured person and which relate to the discomfort, pain,
suffering, injury, or death of the injured person as the result of the
alleged professional negligence shall be inadmissible as evidence of an
admission of liability or as evidence of an admission against interest.
(3) For the purposes of this section:
(a) "Health care provider" has the same meaning provided in RCW
7.70.020.
(b) "Relative" means:
(i) An injured person's spouse, parent, grandparent, stepfather,
stepmother, child, grandchild, brother, sister, half brother, half
sister, or spouse's parents;
(ii) Relationships in (b)(i) of this subsection that are
established with an injured person as a result of adoption; and
(iii) Any person who has a family-type relationship with an injured
person.
(c) "Representative" means a legal guardian, attorney, person
designated to make decisions on behalf of a patient under a medical
power of attorney, or any person recognized in law or custom as a
patient's agent.
NEW SECTION. Sec. 301 Part headings used in this act are not any
part of the law.
NEW SECTION. Sec. 302 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. 303 Section 103 of 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 July 1, 2005.