BILL REQ. #:  H-0532.3 

Read first time 01/20/09.   Referred to Committee on Health Care & Wellness.

     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 declaring an emergency.

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

NEW SECTION.  Sec. 1   It is the intent of the legislature to enhance the delivery of health care to the citizens of the state. 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.
     In an attempt to manage this skyrocketing demand, we have evolved into a highly complex integrated health delivery system with greater specialization. Health care 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.
     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.

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 over-the-counter and prescribed medications by oral, topical, rectal, otic, ophthalmic, or inhaled routes pursuant to a written order, in accordance with section 5 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.

Sec. 3   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, or certain over-the-counter and prescribed medications, as defined in this chapter, but need not be present during procedures to withdraw blood.
     (5) "Health care facility" means any professional service corporation, as defined in chapter 18.100 RCW, 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. 4   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)), 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)) medication, diagnostic agent, and vaccine that the delegatee is authorized to administer. 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.

NEW SECTION.  Sec. 5   A new section is added to chapter 18.135 RCW to read as follows:
     (1) The administration of prescribed medications by a health care assistant is restricted to:
     (a) A list of medications established by the secretary in rule that shall be limited to the following categories and types of medications:
     (i) Over-the-counter medications that may be administered to a patient while in the care of a health care practitioner, such as: Benadryl, acetaminophen, ibuprofen, aspirin, neosporin, polysporin, normal saline, colace, kenalog, and hydrocortisone cream;
     (ii) Nonover-the-counter unit dose medications that may be administered to a patient while in the care of a health care practitioner, such as: Kenalog, hydrocortisone cream, reglan, compazine, zofran, bactroban, albuterol, xopenex, silvadene, gastrointestinal cocktail, fluoride, lmx cream, emla, lat, optic dyes, oral contrast, and oxygen. Within this category of medications, the secretary may make exceptions for certain nonover-the-counter medications that do not come in unit dose forms, such as cream only medications and inhalers.
     (b) Health care assistants who have successfully graduated from an accredited medical assistant program approved by the secretary with a demonstrated competency in the administration of oral, topical, rectal, inhaled, otic, or ophthalmic medications. The secretary shall establish in rule the requirements for initial and continued competency requirements including completion of a minimum of four approved medication administration continuing education units annually.
     (2) A health care practitioner, as defined in RCW 18.135.020, 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.

NEW SECTION.  Sec. 6   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 immediately.