BILL REQ. #:  S-3126.3 

READ FIRST TIME 04/19/09.   

     AN ACT Relating to savings in programs under the supervision of the department of health; amending RCW 43.20.050, 43.20.240, 70.119A.020, 70.119A.050, 70.119A.060, 70.119A.130, 64.44.070, 70.54.220, 70.54.220, 70.104.030, 70.104.050, 70.56.020, 70.56.030, and 70.56.040; providing an effective date; providing an expiration date; and declaring an emergency.

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

Sec. 1   RCW 43.20.050 and 2007 c 343 s 11 are each amended to read as follows:
     (1) The state board of health shall provide a forum for the development of public health policy in Washington state. It is authorized to recommend to the secretary means for obtaining appropriate citizen and professional involvement in all public health policy formulation and other matters related to the powers and duties of the department. It is further empowered to hold hearings and explore ways to improve the health status of the citizenry.
     (a) At least every five years, the state board shall convene regional forums to gather citizen input on public health issues.
     (b) Every two years, in coordination with the development of the state biennial budget, the state board shall prepare the state public health report that outlines the health priorities of the ensuing biennium. The report shall:
     (i) Consider the citizen input gathered at the forums;
     (ii) Be developed with the assistance of local health departments;
     (iii) Be based on the best available information collected and reviewed according to RCW 43.70.050 ((and recommendations from the council));
     (iv) Be developed with the input of state health care agencies. At least the following directors of state agencies shall provide timely recommendations to the state board on suggested health priorities for the ensuing biennium: The secretary of social and health services, the health care authority administrator, the insurance commissioner, the superintendent of public instruction, the director of labor and industries, the director of ecology, and the director of agriculture;
     (v) Be used by state health care agency administrators in preparing proposed agency budgets and executive request legislation;
     (vi) Be submitted by the state board to the governor by January 1st of each even-numbered year for adoption by the governor. The governor, no later than March 1st of that year, shall approve, modify, or disapprove the state public health report.
     (c) In fulfilling its responsibilities under this subsection, the state board may create ad hoc committees or other such committees of limited duration as necessary.
     (2) In order to protect public health, the state board of health shall:
     (a) Adopt rules for group A public water systems, as defined in RCW 70.119A.020, necessary to assure safe and reliable public drinking water and to protect the public health. Such rules shall establish requirements regarding:
     (i) The design and construction of public water system facilities, including proper sizing of pipes and storage for the number and type of customers;
     (ii) Drinking water quality standards, monitoring requirements, and laboratory certification requirements;
     (iii) Public water system management and reporting requirements;
     (iv) Public water system planning and emergency response requirements;
     (v) Public water system operation and maintenance requirements;
     (vi) Water quality, reliability, and management of existing but inadequate public water systems; and
     (vii) Quality standards for the source or supply, or both source and supply, of water for bottled water plants((.));
     (b) Adopt rules as necessary for group B public water systems, as defined in RCW 70.119A.020. The rules shall, at a minimum, establish requirements regarding the initial design and construction of a public water system. The state board of health rules may waive some or all requirements for group B public water systems with fewer than five connections;
     (c) Adopt rules and standards for prevention, control, and abatement of health hazards and nuisances related to the disposal of wastes, solid and liquid, including but not limited to sewage, garbage, refuse, and other environmental contaminants; adopt standards and procedures governing the design, construction, and operation of sewage, garbage, refuse and other solid waste collection, treatment, and disposal facilities;
     (((c))) (d) Adopt rules controlling public health related to environmental conditions including but not limited to heating, lighting, ventilation, sanitary facilities, cleanliness and space in all types of public facilities including but not limited to food service establishments, schools, institutions, recreational facilities and transient accommodations and in places of work;
     (((d))) (e) Adopt rules for the imposition and use of isolation and quarantine;
     (((e))) (f) Adopt rules for the prevention and control of infectious and noninfectious diseases, including food and vector borne illness, and rules governing the receipt and conveyance of remains of deceased persons, and such other sanitary matters as admit of and may best be controlled by universal rule; and
     (((f))) (g) Adopt rules for accessing existing databases for the purposes of performing health related research.
     (3) The state board shall adopt rules for the design, construction, installation, operation, and maintenance of those on-site sewage systems with design flows of less than three thousand five hundred gallons per day.
     (4) The state board may delegate any of its rule-adopting authority to the secretary and rescind such delegated authority.
     (5) All local boards of health, health authorities and officials, officers of state institutions, police officers, sheriffs, constables, and all other officers and employees of the state, or any county, city, or township thereof, shall enforce all rules adopted by the state board of health. In the event of failure or refusal on the part of any member of such boards or any other official or person mentioned in this section to so act, he or she shall be subject to a fine of not less than fifty dollars, upon first conviction, and not less than one hundred dollars upon second conviction.
     (6) The state board may advise the secretary on health policy issues pertaining to the department of health and the state.

Sec. 2   RCW 43.20.240 and 1999 c 153 s 56 are each amended to read as follows:
     (1) The department shall have primary responsibility among state agencies to receive complaints from persons aggrieved by the failure of a public water system. If the remedy to the complaint is not within the jurisdiction of the department, the department shall refer the complaint to the state or local agency that has the appropriate jurisdiction. The department shall take such steps as are necessary to inform other state agencies of their primary responsibility for such complaints and the implementing procedures.
     (2) Each county shall designate a contact person to the department for the purpose of receiving and following up on complaint referrals that are within county jurisdiction. In the absence of any such designation, the county health officer shall be responsible for performing this function.
     (3) The department and each county shall establish procedures for providing a reasonable response to complaints received from persons aggrieved by the failure of a public water system.
     (4) The department and each county shall use all reasonable efforts to assist customers of public water systems in obtaining a dependable supply of water at all times. The availability of resources and the public health significance of the complaint shall be considered when determining what constitutes a reasonable effort.
     (5) The department shall, in consultation with local governments, water utilities, water-sewer districts, public utility districts, and other interested parties, develop a booklet or other single document that will provide to members of the public the following information:
     (a) A summary of state and local law regarding the obligations of public water systems in providing drinking water supplies to their customers;
     (b) A summary of the activities, including planning, rate setting, and compliance, that are to be performed by both local and state agencies;
     (c) The rights of customers of public water systems, including identification of agencies or offices to which they may address the most common complaints regarding the failures or inadequacies of public water systems.
     This booklet or document shall be available to members of the public no later than January 1, 1991.

Sec. 3   RCW 70.119A.020 and 1999 c 118 s 2 are each amended to read as follows:
     Unless the context clearly requires otherwise, the following definitions apply throughout this chapter:
     (1) "Department" means the department of health.
     (2) "Group A public water system" means a public water system with fifteen or more service connections, regardless of the number of people; or a system serving an average of twenty-five or more people per day for sixty or more days within a calendar year, regardless of the number of service connections; or a system serving one thousand or more people for two or more consecutive days.
     (3) "Group B public water system" means a public water system that does not meet the definition of a group A public water system.
     (4) "Local board of health" means the city, town, county, or district board of health.
     (((3))) (5) "Local health jurisdiction" means an entity created under chapter 70.05, 70.08, or 70.46 RCW which provides public health services to persons within the area.
     (((4))) (6) "Public water system" means any system, excluding a system serving only one single-family residence and a system with four or fewer connections all of which serve residences on the same farm, providing water for human consumption through pipes or other constructed conveyances, including any collection, treatment, storage, or distribution facilities under control of the purveyor and used primarily in connection with the system; and collection or pretreatment storage facilities not under control of the purveyor but primarily used in connection with the system, including:
     (a) Any collection, treatment, storage, and distribution facilities under control of the purveyor and used primarily in connection with such system; and
     (b) Any collection or pretreatment storage facilities not under control of the purveyor which are primarily used in connection with such system.
     (((5))) (7) "Order" means a written direction to comply with a provision of the regulations adopted under RCW 43.20.050(2) (a) and (b) or 70.119.050 or to take an action or a series of actions to comply with the regulations.
     (((6))) (8) "Purveyor" means any agency or subdivision of the state or any municipal corporation, firm, company, mutual or cooperative association, institution, partnership, or person or any other entity, that owns or operates a public water system. It also means the authorized agents of any such entities.
     (((7))) (9) "Regulations" means rules adopted to carry out the purposes of this chapter.
     (((8))) (10) "Federal safe drinking water act" means the federal safe drinking water act, 42 U.S.C. Sec. 300f et seq., as now in effect or hereafter amended.
     (((9))) (11) "Area-wide waivers" means a waiver granted by the department as a result of a geographically based testing program meeting required provisions of the federal safe drinking water act.
     (((10))) (12) "Local health officer" means the legally qualified physician who has been appointed as the health officer for the city, town, county, or district public health department.
     (((11))) (13) "Person" includes, but is not limited to, natural persons, municipal corporations, governmental agencies, firms, companies, mutual or cooperative associations, institutions, and partnerships. It also means the authorized agents of any such entities.
     (((12))) (14) "Public health emergency" means a declaration by an authorized health official of a situation in which either illness, or exposure known to cause illness, is occurring or is imminent.
     (((13))) (15) "Secretary" means the secretary of the department of health.
     (((14))) (16) "State board of health" is the board created by RCW 43.20.030.

Sec. 4   RCW 70.119A.050 and 1993 c 305 s 3 are each amended to read as follows:
     Each local board of health that is enforcing the regulations ((under an agreement with the department allocating state and local responsibility)) regarding public water systems is authorized to impose and collect civil penalties for violations within the area of its responsibility under the same limitations and requirements imposed upon the department by RCW 70.119A.030 and 70.119A.040, except that judgment shall be entered in the name of the local board (([and])) and penalties shall be placed into the general fund of the county, city, or town operating the local board of health.

Sec. 5   RCW 70.119A.060 and 1995 c 376 s 3 are each amended to read as follows:
     (1) ((In order)) To assure safe and reliable public drinking water and to protect the public health((,)):
     (a) Public water systems shall comply with all applicable federal, state, and local rules; and
     (b) Group A public water systems shall:
     (((a))) (i) Protect the water sources used for drinking water;
     (((b))) (ii) Provide treatment adequate to assure that the public health is protected;
     (((c))) (iii) Provide and effectively operate and maintain public water system facilities;
     (((d))) (iv) Plan for future growth and assure the availability of safe and reliable drinking water;
     (((e))) (v) Provide the department with the current names, addresses, and telephone numbers of the owners, operators, and emergency contact persons for the system, including any changes to this information, and provide to users the name and twenty-four hour telephone number of an emergency contact person; and
     (((f))) (vi) Take whatever investigative or corrective action is necessary to assure that a safe and reliable drinking water supply is continuously available to users.
     (2) No new public water system may be approved or created unless: (a) It is owned or operated by a satellite system management agency established under RCW 70.116.134 and the satellite system management system complies with financial viability requirements of the department; or (b) a satellite management system is not available and it is determined that the new system has sufficient management and financial resources to provide safe and reliable service. The approval of any new system that is not owned by a satellite system management agency shall be conditioned upon future management or ownership by a satellite system management agency, if such management or ownership can be made with reasonable economy and efficiency, or upon periodic review of the system's operational history to determine its ability to meet the department's financial viability and other operating requirements. The department and local health jurisdictions shall enforce this requirement under authority provided under this chapter, chapter 70.116, or 70.05 RCW, or other authority governing the approval of new water systems by the department or a local jurisdiction.
     (3) The department and local health jurisdictions shall carry out the rules and regulations of the state board of health adopted pursuant to RCW 43.20.050(2) (a) and (b) and other rules adopted by the department relating to public water systems.

Sec. 6   RCW 70.119A.130 and 1995 c 376 s 9 are each amended to read as follows:
     (1) Local governments may establish separate operating permit requirements for public water systems provided the operating permit requirements have been approved by the department. The department shall not approve local operating permit requirements unless the local system will result in an increased level of service to the public water system. There shall not be duplicate operating permit requirements imposed by local governments and the department.
     (2) Local governments may establish requirements for group B public water systems in addition to those established by rule by the state board of health pursuant to RCW 43.20.050(2) or other rules adopted by the department, provided that the requirements are at least as stringent as the state requirements.

Sec. 7   RCW 64.44.070 and 2006 c 339 s 207 are each amended to read as follows:
     (1) The state board of health shall promulgate rules and standards for carrying out the provisions in this chapter in accordance with chapter 34.05 RCW, the administrative procedure act. The local board of health and the local health officer are authorized to exercise such powers as may be necessary to carry out this chapter. The department ((shall)) may provide technical assistance to local health boards and health officers to carry out their duties under this chapter.
     (2) The department shall adopt rules for decontamination of a property used as a laboratory for the production of controlled substances and methods for the testing of porous and nonporous surfaces, groundwater, surface water, soil, and septic tanks for contamination. The rules shall establish decontamination standards for hazardous chemicals, including but not limited to methamphetamine, lead, mercury, and total volatile organic compounds.
     (((3) The department shall adopt rules regarding independent third party sampling including those pertaining to:
     (a) Verification of possible property contamination due to the illegal manufacture of controlled substances;
     (b) Verification of satisfactory decontamination of property deemed contaminated and unfit for use;
     (c) Certification of independent third party samplers;
     (d) Qualifications and performance standards for independent third party samplers;
     (e) Administration of background checks for third party sampler applicants; and
     (f) The denial, suspension, or revocation of independent third party sampler certification.
     (4) For the purposes of this section, an independent third party sampler is a person who is not an employee, agent, representative, partner, joint venturer, shareholder, or parent or subsidiary company of the authorized contractor, the authorized contractor's company, or the property owner.))

Sec. 8   RCW 70.54.220 and 1988 c 276 s 5 are each amended to read as follows:
     All persons licensed or certified by the state of Washington to provide prenatal care or to practice medicine shall provide information regarding the use and availability of prenatal tests to all pregnant women in their care ((within the time limits prescribed by department rules and in accordance with standards established by those rules)).

Sec. 9   RCW 70.54.220 and 2008 c 56 s 2 are each amended to read as follows:
     (((1))) All persons licensed or certified by the state of Washington to provide prenatal care or to practice medicine shall provide information to all pregnant women in their care regarding:
     (((a))) (1) The use and availability of prenatal tests; and
     (((b))) (2) Using objective and standardized information: (((i))) (a) The differences between and potential benefits and risks involved in public and private cord blood banking that is sufficient to allow a pregnant woman to make an informed decision before her third trimester of pregnancy on whether to participate in a private or public cord blood banking program; and (((ii))) (b) the opportunity to donate, to a public cord blood bank, blood and tissue extracted from the placenta and umbilical cord following delivery of a newborn child.
     (((2) The information required by this section must be provided within the time limits prescribed by department rules and in accordance with standards established by those rules.))

Sec. 10   RCW 70.104.030 and 1991 c 3 s 357 are each amended to read as follows:
     (1) The department of health ((shall)) may investigate all suspected human cases of pesticide poisoning and such cases of suspected pesticide poisoning of animals that may relate to human illness. The department shall establish time periods by rule to determine investigation response time. Time periods shall range from immediate to forty-eight hours to initiate an investigation, depending on the severity of the case or suspected case of pesticide poisoning.
     In order to adequately investigate such cases, the department shall have the power to:
     (a) Take all necessary samples and human or animal tissue specimens for diagnostic purposes: PROVIDED, That tissue, if taken from a living human, shall be taken from a living human only with the consent of a person legally qualified to give such consent;
     (b) Secure any and all such information as may be necessary to adequately determine the nature and causes of any case of pesticide poisoning.
     (2) The department shall((, by rule adopted pursuant to the Administrative Procedure Act, chapter 34.05 RCW, with due notice and a hearing for the adoption of permanent rules, establish procedures for the prevention of any recurrence of poisoning and the department shall)) immediately notify the department of agriculture, the department of labor and industries, and other appropriate agencies of the results of its investigation for such action as the other departments or agencies deem appropriate. The notification of such investigations and their results may include recommendations for further action by the appropriate department or agency.

Sec. 11   RCW 70.104.050 and 1991 c 3 s 359 are each amended to read as follows:
     The department of health ((shall)) may investigate human exposure to pesticides, and in order to carry out such investigations shall have authority to secure and analyze appropriate specimens of human tissue and samples representing sources of possible exposure.

Sec. 12   RCW 70.56.020 and 2008 c 136 s 1 are each amended to read as follows:
     (1) The legislature intends to establish an adverse health events and incident notification and reporting system that is designed to facilitate quality improvement in the health care system, improve patient safety, assist the public in making informed health care choices, and decrease medical errors in a nonpunitive manner. The notification and reporting system shall not be designed to punish errors by health care practitioners or health care facility employees.
     (2) When a medical facility confirms that an adverse event has occurred, it shall submit to the department of health:
     (a) Notification of the event, with the date, type of adverse event, and any additional contextual information the facility chooses to provide, within forty-eight hours; and
     (b) A report regarding the event within forty-five days.
     The notification and report shall be submitted to the department using the internet-based system established under RCW 70.56.040(2) if the system is operational.
     (c) A medical facility may amend the notification or report within sixty days of the submission.
     (3) The notification and report shall be filed in a format specified by the department after consultation with medical facilities and the independent entity if an independent entity has been contracted for under RCW 70.56.040(1). The format shall identify the facility, but shall not include any identifying information for any of the health care professionals, facility employees, or patients involved. This provision does not modify the duty of a hospital to make a report to the department of health or a disciplinary authority if a licensed practitioner has committed unprofessional conduct as defined in RCW 18.130.180.
     (4) As part of the report filed under subsection (2)(b) of this section, the medical facility must conduct a root cause analysis of the event, describe the corrective action plan that will be implemented consistent with the findings of the analysis, or provide an explanation of any reasons for not taking corrective action. The department shall adopt rules, in consultation with medical facilities and the independent entity if an independent entity has been contracted for under RCW 70.56.040(1), related to the form and content of the root cause analysis and corrective action plan. In developing the rules, consideration shall be given to existing standards for root cause analysis or corrective action plans adopted by the joint commission on accreditation of health facilities and other national or governmental entities.
     (5) If, in the course of investigating a complaint received from an employee of a medical facility, the department determines that the facility has not provided notification of an adverse event or undertaken efforts to investigate the occurrence of an adverse event, the department shall direct the facility to provide notification or to undertake an investigation of the event.
     (6) The protections of RCW 43.70.075 apply to notifications of adverse events that are submitted in good faith by employees of medical facilities.

Sec. 13   RCW 70.56.030 and 2007 c 259 s 13 are each amended to read as follows:
     (1) The department shall:
     (a) Receive and investigate, where necessary, notifications and reports of adverse events, including root cause analyses and corrective action plans submitted as part of reports, and communicate to individual facilities the department's conclusions, if any, regarding an adverse event reported by a facility;
     (b) ((Provide to the Washington state quality forum established in RCW 41.05.029 such information from the adverse health events and incidents reports made under this chapter as the department and the Washington state quality forum determine will assist in the Washington state quality forum's research regarding health care quality, evidence-based medicine, and patient safety. Any shared information must be aggregated and not identify an individual medical facility. As determined by the department and the Washington state quality forum, selected shared information may be disseminated on the Washington state quality forum's web site and through other appropriate means; and
     (c))) Adopt rules as necessary to implement this chapter.
     (2) The department may enforce the reporting requirements of RCW 70.56.020 using its existing enforcement authority provided in chapter 18.46 RCW for childbirth centers, chapter 70.41 RCW for hospitals, and chapter 71.12 RCW for psychiatric hospitals.

Sec. 14   RCW 70.56.040 and 2008 c 136 s 2 are each amended to read as follows:
     (1) To the extent funds are appropriated specifically for this purpose, the department shall contract with a qualified, independent entity to receive notifications and reports of adverse events and incidents, and carry out the activities specified in this section. In establishing qualifications for, and choosing the independent entity, the department shall strongly consider the patient safety organization criteria included in the federal patient safety and quality improvement act of 2005, P.L. 109-41, and any regulations adopted to implement this chapter.
     (2) If an independent entity is contracted for under subsection (1) of this section, the independent entity shall:
     (a) In collaboration with the department of health, establish an internet-based system for medical facilities and the health care workers of a medical facility to submit notifications and reports of adverse events and incidents, which shall be accessible twenty-four hours a day, seven days a week. The system shall be a portal to report both adverse events and incidents, and notifications and reports of adverse events shall be immediately transmitted to the department. The system shall be a secure system that protects the confidentiality of personal health information and provider and facility specific information submitted in notifications and reports, including appropriate encryption and an accurate means of authenticating the identity of users of the system. When the system becomes operational, medical facilities shall submit all notifications and reports by means of the system;
     (b) Collect, analyze, and evaluate data regarding notifications and reports of adverse events and incidents, including the identification of performance indicators and patterns in frequency or severity at certain medical facilities or in certain regions of the state;
     (c) Develop recommendations for changes in health care practices and procedures, which may be instituted for the purpose of reducing the number or severity of adverse events and incidents;
     (d) Directly advise reporting medical facilities of immediate changes that can be instituted to reduce adverse events or incidents;
     (e) Issue recommendations to medical facilities on a facility-specific or on a statewide basis regarding changes, trends, and improvements in health care practices and procedures for the purpose of reducing the number and severity of adverse events or incidents. Prior to issuing recommendations, consideration shall be given to the following factors: Expectation of improved quality of care, implementation feasibility, other relevant implementation practices, and the cost impact to patients, payers, and medical facilities. Statewide recommendations shall be issued to medical facilities on a continuing basis and shall be published and posted on a publicly accessible web site. The recommendations made to medical facilities under this section shall not be considered mandatory for licensure purposes unless they are adopted by the department as rules pursuant to chapter 34.05 RCW; and
     (f) Monitor implementation of reporting systems addressing adverse events or their equivalent in other states and make recommendations to the governor and the legislature as necessary for modifications to this chapter to keep the system as nearly consistent as possible with similar systems in other states.
     (3)(a) The independent entity shall report no later than January 1, 2008, and annually thereafter in any year that an independent entity is contracted for under subsection (1) of this section to the governor and the legislature on the activities under this chapter in the preceding year. The report shall include:
     (i) The number of adverse events and incidents reported by medical facilities, in the aggregate, on a geographical basis, and a summary of actions taken by facilities in response to the adverse events or incidents;
     (ii) In the aggregate, the information derived from the data collected, including any recognized trends concerning patient safety;
     (iii) Recommendations for statutory or regulatory changes that may help improve patient safety in the state; and
     (iv) Information, presented in the aggregate, to inform and educate consumers and providers, on best practices and prevention tools that medical facilities are implementing to prevent adverse events as well as other patient safety initiatives medical facilities are undertaking to promote patient safety.
     (b) The annual report shall be made available for public inspection and shall be posted on the department's and the independent entity's web site.
     (4) The independent entity shall conduct all activities under this section in a manner that preserves the confidentiality of facilities, documents, materials, or information made confidential by RCW 70.56.050.
     (5) Medical facilities and health care workers may provide notification of incidents to the independent entity. The notification shall be filed in a format specified by the independent entity, after consultation with the department and medical facilities, and shall identify the facility but shall not include any identifying information for any of the health care professionals, facility employees, or patients involved. This provision does not modify the duty of a hospital to make a report to the department or a disciplinary authority if a licensed practitioner has committed unprofessional conduct as defined in RCW 18.130.180. The protections of RCW 43.70.075 apply to notifications of incidents that are submitted in good faith by employees of medical facilities.

NEW SECTION.  Sec. 15   Section 8 of this act expires July 1, 2010.

NEW SECTION.  Sec. 16   Section 9 of this act takes effect July 1, 2010.

NEW SECTION.  Sec. 17   Except for section 9 of this act, 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.