BILL REQ. #:  H-1816.1 

READ FIRST TIME 02/19/09.   

     AN ACT Relating to the practice of health care assistants; amending RCW 18.135.010, 18.135.020, and 18.135.065; adding a new section to chapter 18.135 RCW; creating a new section; and providing an expiration date.

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

NEW SECTION.  Sec. 1   (1) It is the intent of the legislature to enhance the delivery of health care to the citizens of the state.
     (a) For many years health care assistants, certified with the state and supervised by a licensed health care practitioner, have been an integral and often overlooked part of the state's health care delivery system. It is not surprising then that as the demand for health care services has exploded over the past twenty years, so too have the demands on licensed health care practitioners, and in turn those that assist those practitioners.
     (b) In an attempt to manage this skyrocketing demand, a highly complex integrated health delivery system characterized by greater specialization has evolved. Health care assistants, including medical assistants, have responded to these changes by developing greater training and education opportunities through nationally accredited programs. This additional training, when appropriately supervised, can be of great assistance to our licensed health care practitioners.
     (c) It is important for the legislature to look for new ways to harness the training of our health care practitioners, and those that assist them, in order to alleviate the stress on our current health care delivery system. With this in mind, the legislature encourages some minor expansions to the scope of practice of registered health care assistants, so long as there are clearly defined limitations to their scope expressly linked to education, training, and supervision.
     (2) Within the existing resources, the department of health shall conduct a review under chapter 18.120 regarding the regulation and the scope of practice of medical assistants.

Sec. 2   RCW 18.135.010 and 2008 c 58 s 1 are each amended to read as follows:
     It is in this state's public interest that limited authority to: (1) Administer skin tests and subcutaneous, intradermal, intramuscular, and intravenous injections; (2) perform minor invasive procedures to withdraw blood; ((and)) (3) administer vaccines in accordance with RCW 18.135.120; and (4) administer certain drugs, in accordance with section 3 of this act be granted to health care assistants who are not so authorized under existing licensing statutes, subject to such regulations as will ensure the protection of the health and safety of the patient.

NEW SECTION.  Sec. 3   A new section is added to chapter 18.135 RCW to read as follows:
     (1)(a) The administration of drugs by a health care assistant is restricted to oral, topical, rectal, otic, ophthalmic, or inhaled routes administered pursuant to a written order of a supervising health care practitioner. The drugs authorized for administration under this section are limited to the following:
     (i) Over-the-counter drugs that may be administered to a patient while in the care of a health care practitioner are: Benadryl, acetaminophen, ibuprofen, aspirin, neosporin, polysporin, normal saline, colace, kenalog, and hydrocortisone cream;
     (ii) Nonover-the-counter unit dose legend drugs that may be administered to a patient while in the care of a health care practitioner are: Kenalog, hydrocortisone cream, reglan, compazine, zofran, bactroban, albuterol, xopenex, silvadene, gastrointestinal cocktail, fluoride, lmx cream, emla, lat, optic dyes, oral contrast, and oxygen.
     (b) Only health care assistants who are certified as category C or E assistants by the department of health may administer the oral drugs specified in (a) of this subsection.
     (c) Health care assistants authorized to administer certain over-the-counter and legend drugs under (a) of this subsection must demonstrate initial and ongoing competency to administer specific drugs as determined by the health care practitioner.
     (2) A health care practitioner must administer a medication if:
     (a) A patient is unable to physically ingest or safely apply a medication independently or with assistance; or
     (b) A patient is unable to indicate an awareness that he or she is taking a medication.
     (3) This section expires July 1, 2013.

Sec. 4   RCW 18.135.020 and 2008 c 58 s 2 are each amended to read as follows:
     The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.
     (1) "Secretary" means the secretary of health.
     (2) "Health care assistant" means an unlicensed person who assists a licensed health care practitioner in providing health care to patients pursuant to this chapter. However, persons trained by a federally approved end-stage renal disease facility who perform end-stage renal dialysis in the home setting are exempt from certification under this chapter.
     (3) "Health care practitioner" means:
     (a) A physician licensed under chapter 18.71 RCW;
     (b) An osteopathic physician or surgeon licensed under chapter 18.57 RCW; or
     (c) Acting within the scope of their respective licensure, a podiatric physician and surgeon licensed under chapter 18.22 RCW, a registered nurse or advanced registered nurse practitioner licensed under chapter 18.79 RCW, a naturopath licensed under chapter 18.36A RCW, a physician assistant licensed under chapter 18.71A RCW, or an osteopathic physician assistant licensed under chapter 18.57A RCW.
     (4) "Supervision" means supervision of procedures permitted pursuant to this chapter by a health care practitioner who is physically present and is immediately available in the facility during the administration of injections or vaccines, as defined in this chapter, or certain drugs as provided in section 3 of this act, but need not be present during procedures to withdraw blood.
     (5) "Health care facility" means any hospital, hospice care center, licensed or certified health care facility, health maintenance organization regulated under chapter 48.46 RCW, federally qualified health maintenance organization, renal dialysis center or facility federally approved under 42 C.F.R. 405.2100, blood bank federally licensed under 21 C.F.R. 607, or clinical laboratory certified under 20 C.F.R. 405.1301-16.
     (6) "Delegation" means direct authorization granted by a licensed health care practitioner to a health care assistant to perform the functions authorized in this chapter which fall within the scope of practice of the delegator and which are not within the scope of practice of the delegatee.

Sec. 5   RCW 18.135.065 and 2008 c 58 s 3 are each amended to read as follows:
     (1) Each delegator, as defined under RCW 18.135.020(6), shall maintain a list of((: (a))) specific ((medications and)) drugs, diagnostic agents, and vaccines, and the route of administration of each((, that he or she has authorized for injection; and (b) the vaccines that he or she has authorized for administration)) drug, diagnostic agent, and vaccine that the delegatee is authorized to administer under this chapter. Both the delegator and delegatee shall sign the above list, indicating the date of each signature. The signed list shall be forwarded to the secretary of the department of health and shall be available for review.
     (2) Delegatees are prohibited from administering any controlled substance as defined in RCW 69.50.101(d), any experimental drug, and any cancer chemotherapy agent unless a delegator is physically present in the immediate area where the drug is administered.