BILL REQ. #:  S-4025.2 

Read first time 01/15/08.   Referred to Committee on Health & Long-Term Care.

     AN ACT Relating to exercise of religious beliefs and conscience in the practice of pharmacy; amending RCW 18.64.005, 18.64.160, and 18.130.180; adding a new section to chapter 18.64 RCW; and creating a new section.

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

NEW SECTION.  Sec. 1   The legislature finds that Planned Parenthood and the Oregon state board of pharmacy have reached an agreement after careful, thoughtful, and skilled negotiations on how to ensure that patients receive their prescription drugs in a reasonable and timely manner while respecting the religious and moral beliefs of health care providers. We applaud their efforts. The patients and providers in Washington will benefit greatly from a similar compromise.

NEW SECTION.  Sec. 2   A new section is added to chapter 18.64 RCW to read as follows:
     (1) The legislature recognizes that every pharmacist and pharmacy possesses a fundamental right to exercise the pharmacist's or pharmacy's religious beliefs and conscience. The legislature further recognizes that in developing public policy, conflicting religious and moral beliefs must be respected. Therefore, while recognizing the right of conscientious objection to participating in specific health services, the state also recognizes the right of patients to receive health services.
     (2)(a) No individual licensed pharmacist or pharmacy may be required by law or contract in any circumstances to participate in the provision of a specific service if the pharmacist or pharmacy objects to so doing for reason of conscience or religion. No person may be discriminated against in employment or professional privileges because of such objection.
     (b) The provisions of this section are not intended to result in interference with a patient's right to receive approved and lawfully prescribed medications and information or drugs and devices approved by the United States food and drug administration for restricted or over-the-counter distribution by pharmacies in a timely and professional manner and that the patients are not burdened by the pharmacist's individual beliefs.
     (3) Each pharmacist or pharmacy shall:
     (a) Adopt a written policy and procedures that address the issues of pharmacists' moral, ethical, and professional responsibilities and, if appropriate, allowing the pharmacist to exercise his or her choice to not participate, and at the same time not interfere with a patient's right to receive appropriate and lawfully prescribed or over-the-counter drug therapy or drugs and devices approved by the United States food and drug administration for restricted or over-the-counter distribution by pharmacies. These policies may include dispensing of drugs and devices by another pharmacist on site or arranging for the prescription to be dispensed by a pharmacist at another site;
     (b) Provide a written notice to patients listing services that the pharmacist or pharmacy refuses to dispense for reason of conscience or religion;
     (c) Provide written information describing how an enrollee may directly access services in an expeditious manner; and
     (d) Ensure that enrollees refused services under this section have prompt access to the information developed pursuant to (c) of this subsection.
     (4) The board shall establish a mechanism or mechanisms to recognize the right of pharmacists and pharmacies to exercise religious beliefs and conscience while ensuring patients timely access to services and to assure prompt payment to service providers.

Sec. 3   RCW 18.64.005 and 1990 c 83 s 1 are each amended to read as follows:
     The board shall:
     (1) Regulate the practice of pharmacy and enforce all laws placed under its jurisdiction;
     (2) Prepare or determine the nature of, and supervise the grading of, examinations for applicants for pharmacists' licenses;
     (3) Establish the qualifications for licensure of pharmacists or pharmacy interns;
     (4) Conduct hearings for the revocation or suspension of licenses, permits, registrations, certificates, or any other authority to practice granted by the board, which hearings may also be conducted by an administrative law judge appointed under chapter 34.12 RCW;
     (5) Issue subpoenas and administer oaths in connection with any hearing, or disciplinary proceeding held under this chapter or any other chapter assigned to the board;
     (6) Assist the regularly constituted enforcement agencies of this state in enforcing all laws pertaining to drugs, controlled substances, and the practice of pharmacy, or any other laws or rules under its jurisdiction;
     (7) ((Promulgate)) Adopt rules for the dispensing, distribution, wholesaling, and manufacturing of drugs and devices and the practice of pharmacy for the protection and promotion of the public health, safety, and welfare. Violation of any such rules shall constitute grounds for refusal, suspension, or revocation of licenses or any other authority to practice issued by the board. However, it shall not be a violation for a pharmacist or pharmacy to exercise the pharmacist's or pharmacy's fundamental right to exercise religious beliefs or conscience when choosing to not dispense drugs, devices, medication, or information;
     (8) Adopt rules that allow a pharmacist to exercise his or her choice not to dispense a restricted or over-the-counter drug or device while accommodating the needs of the patient. Rules and policies must require any objecting pharmacist to inform the pharmacist in charge in advance so that the pharmacist in charge can reasonably accommodate that objection before a patient presents a prescription or makes a request for drugs or devices approved by the United States food and drug administration for restricted and over-the-counter distribution by pharmacies;
     (9) Adopt rules establishing and governing continuing education requirements for pharmacists and other licensees applying for renewal of licenses under this chapter;
     (((9))) (10) Be immune, collectively and individually, from suit in any action, civil or criminal, based upon any disciplinary proceedings or other official acts performed as members of such board. Such immunity shall apply to employees of the department when acting in the course of disciplinary proceedings;
     (((10))) (11) Suggest strategies for preventing, reducing, and eliminating drug misuse, diversion, and abuse, including professional and public education, and treatment of persons misusing and abusing drugs;
     (((11))) (12) Conduct or encourage educational programs to be conducted to prevent the misuse, diversion, and abuse of drugs for health care practitioners and licensed or certified health care facilities;
     (((12))) (13) Monitor trends of drug misuse, diversion, and abuse and make periodic reports to disciplinary boards of licensed health care practitioners and education, treatment, and appropriate law enforcement agencies regarding these trends;
     (((13))) (14) Enter into written agreements with all other state and federal agencies with any responsibility for controlling drug misuse, diversion, or abuse and with health maintenance organizations, health care service contractors, and health care providers to assist and promote coordination of agencies responsible for ensuring compliance with controlled substances laws and to monitor observance of these laws and cooperation between these agencies. The department of social and health services, the department of labor and industries, and any other state agency including licensure disciplinary boards, shall refer all apparent instances of over-prescribing by practitioners and all apparent instances of legend drug overuse to the department. The department shall also encourage such referral by health maintenance organizations, health service contractors, and health care providers.

Sec. 4   RCW 18.64.160 and 1993 c 367 s 13 are each amended to read as follows:
     In addition to the grounds under RCW 18.130.170 and 18.130.180, the board of pharmacy may take disciplinary action against the license of any pharmacist or intern upon proof that:
     (1) His or her license was procured through fraud, misrepresentation, or deceit;
     (2) In the event that a pharmacist is determined by a court of competent jurisdiction to be mentally incompetent, the pharmacist shall automatically have his or her license suspended by the board upon the entry of the judgment, regardless of the pendency of an appeal;
     (3) He or she has knowingly violated or permitted the violation of any provision of any state or federal law, rule, or regulation governing the possession, use, distribution, or dispensing of drugs, including, but not limited to, the violation of any provision of this chapter, Title 69 RCW, or rule or regulation of the board. However, the board shall not adopt any rule that infringes in any way on a pharmacist's or pharmacy's fundamental legal right to exercise the pharmacist's or pharmacy's religious beliefs with regard to dispensing lawfully prescribed or over-the-counter drug therapy, drugs, devices, medication, or information;
     (4) He or she has knowingly allowed any unlicensed person to take charge of a pharmacy or engage in the practice of pharmacy, except a pharmacy intern or pharmacy assistant acting as authorized in this chapter or chapter 18.64A RCW in the presence of and under the immediate supervision of a licensed pharmacist;
     (5) He or she has compounded, dispensed, or caused the compounding or dispensing of any drug or device which contains more or less than the equivalent quantity of ingredient or ingredients specified by the person who prescribed such drug or device: PROVIDED, HOWEVER, That nothing herein shall be construed to prevent the pharmacist from exercising professional judgment in the preparation or providing of such drugs or devices.

Sec. 5   RCW 18.130.180 and 1995 c 336 s 9 are each amended to read as follows:
     The following conduct, acts, or conditions constitute unprofessional conduct for any license holder or applicant under the jurisdiction of this chapter:
     (1) The commission of any act involving moral turpitude, dishonesty, or corruption relating to the practice of the person's profession, whether the act constitutes a crime or not. If the act constitutes a crime, conviction in a criminal proceeding is not a condition precedent to disciplinary action. Upon such a conviction, however, the judgment and sentence is conclusive evidence at the ensuing disciplinary hearing of the guilt of the license holder or applicant of the crime described in the indictment or information, and of the person's violation of the statute on which it is based. For the purposes of this section, conviction includes all instances in which a plea of guilty or nolo contendere is the basis for the conviction and all proceedings in which the sentence has been deferred or suspended. Nothing in this section abrogates rights guaranteed under chapter 9.96A RCW;
     (2) Misrepresentation or concealment of a material fact in obtaining a license or in reinstatement thereof;
     (3) All advertising which is false, fraudulent, or misleading;
     (4) Incompetence, negligence, or malpractice which results in injury to a patient or which creates an unreasonable risk that a patient may be harmed. The use of a nontraditional treatment by itself shall not constitute unprofessional conduct, provided that it does not result in injury to a patient or create an unreasonable risk that a patient may be harmed;
     (5) Suspension, revocation, or restriction of the individual's license to practice any health care profession by competent authority in any state, federal, or foreign jurisdiction, a certified copy of the order, stipulation, or agreement being conclusive evidence of the revocation, suspension, or restriction;
     (6) The possession, use, prescription for use, or distribution of controlled substances or legend drugs in any way other than for legitimate or therapeutic purposes, diversion of controlled substances or legend drugs, the violation of any drug law, or prescribing controlled substances for oneself;
     (7) Violation of any state or federal statute or administrative rule regulating the profession in question, including any statute or rule defining or establishing standards of patient care or professional conduct or practice;
     (8) Failure to cooperate with the disciplining authority by:
     (a) Not furnishing any papers or documents;
     (b) Not furnishing in writing a full and complete explanation covering the matter contained in the complaint filed with the disciplining authority;
     (c) Not responding to subpoenas issued by the disciplining authority, whether or not the recipient of the subpoena is the accused in the proceeding; or
     (d) Not providing reasonable and timely access for authorized representatives of the disciplining authority seeking to perform practice reviews at facilities utilized by the license holder;
     (9) Failure to comply with an order issued by the disciplining authority or a stipulation for informal disposition entered into with the disciplining authority;
     (10) Aiding or abetting an unlicensed person to practice when a license is required;
     (11) Violations of rules established by any health agency;
     (12) Practice beyond the scope of practice as defined by law or rule;
     (13) Misrepresentation or fraud in any aspect of the conduct of the business or profession;
     (14) Failure to adequately supervise auxiliary staff to the extent that the consumer's health or safety is at risk;
     (15) Engaging in a profession involving contact with the public while suffering from a contagious or infectious disease involving serious risk to public health;
     (16) Promotion for personal gain of any unnecessary or inefficacious drug, device, treatment, procedure, or service;
     (17) Conviction of any gross misdemeanor or felony relating to the practice of the person's profession. For the purposes of this subsection, conviction includes all instances in which a plea of guilty or nolo contendere is the basis for conviction and all proceedings in which the sentence has been deferred or suspended. Nothing in this section abrogates rights guaranteed under chapter 9.96A RCW;
     (18) The procuring, or aiding or abetting in procuring, a criminal abortion;
     (19) The offering, undertaking, or agreeing to cure or treat disease by a secret method, procedure, treatment, or medicine, or the treating, operating, or prescribing for any health condition by a method, means, or procedure which the licensee refuses to divulge upon demand of the disciplining authority;
     (20) The willful betrayal of a practitioner-patient privilege as recognized by law;
     (21) Violation of chapter 19.68 RCW;
     (22) Interference with an investigation or disciplinary proceeding by willful misrepresentation of facts before the disciplining authority or its authorized representative, or by the use of threats or harassment against any patient or witness to prevent them from providing evidence in a disciplinary proceeding or any other legal action, or by the use of financial inducements to any patient or witness to prevent or attempt to prevent him or her from providing evidence in a disciplinary proceeding;
     (23) Current misuse of:
     (a) Alcohol;
     (b) Controlled substances; or
     (c) Legend drugs;
     (24) Abuse of a client or patient or sexual contact with a client or patient;
     (25) Acceptance of more than a nominal gratuity, hospitality, or subsidy offered by a representative or vendor of medical or health-related products or services intended for patients, in contemplation of a sale or for use in research publishable in professional journals, where a conflict of interest is presented, as defined by rules of the disciplining authority, in consultation with the department, based on recognized professional ethical standards;
     (26) Interference with a patient's right to receive expeditious, professional prescription services and information on drugs and devices approved by the United States food and drug administration for restricted distribution by pharmacies. The legal fundamental right by pharmacists or pharmacies to exercise the pharmacist's or pharmacy's religious beliefs and conscience and to choose whether or not to participate in activities the pharmacist or pharmacy finds morally or ethically objectionable, including but not limited to the dispensing of a drug, medication, information, or device, does not constitute unprofessional conduct; provided that accommodation has been offered and it does not result in injury to a patient or create an unreasonable risk that a patient will be harmed; and provided further that accommodation does not include permission to lecture the patient;
     (27) Lecturing by a pharmacist to a patient about the pharmacist's moral or religious beliefs, violating the patient's privacy, or destroying, confiscating, or otherwise tampering with the patient's prescription.