READ FIRST TIME 02/23/09.   

     AN ACT Relating to correctional facility policies regarding medication management; amending RCW 70.48.020; adding a new section to chapter 18.64 RCW; adding a new section to chapter 70.48 RCW; and creating new sections.

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

NEW SECTION.  Sec. 1   (1) When funded, the Washington association of sheriffs and police chiefs shall convene a jail medication management work group to develop a model policy regarding the management of medications in jails, to be applicable to jails as defined in RCW 70.48.020. The work group shall address medication management for all units of local government that operate jails that do not have an on-site pharmacy nor own or operate, in whole or in part, a pharmacy. The model policy shall be designed to reflect best practices regarding medication management and to provide guidance in the areas specified under this section.
     (2) In developing the model policy, the work group shall include members of the pharmaceutical community, including the Washington state pharmacy association and the board of pharmacy, department of health, and members of the nursing community, including the Washington state nurses association. The work group shall review and consider the current policies and practices of cities and counties throughout the state, as directed in RCW 70.48.071, other state policies and practices, and the standards of national organizations, such as the national commission on correctional health care and the American jail association.
     (3) The jail medication management work group shall present the final model policy to the Washington association of sheriffs and police chiefs for adoption or rejection by December 31, 2009. Any minority position related to the substance of the final model policy shall be presented as an addendum to the policy.
     (4) The model policy developed by the association shall provide written guidelines regarding jail policies and procedures for the proper dispensing, storage, control, delivery, administration, and disposal of medications. The guidelines shall address the following matters:
     (a) Provision for agreement between the jail and a licensed pharmacist, pharmacy, or other licensed health care provider or health care facility to ensure access to pharmaceutical services on a twenty-four hour a day basis, including consultation and dispensing services;
     (b) Intake and screening for inmate medical conditions requiring pharmaceutical services, and evaluation and verification of any pharmaceuticals or medications an inmate has in his or her possession at intake;
     (c) Notice to inmates of jail policies for gaining access to pharmaceutical services during confinement;
     (d) Verifying and recording that medications have or have not been delivered, administered, and ingested by an inmate;
     (e) Reporting by the responsible pharmacist to the jail administrator or chief law enforcement executive regarding services provided to the jail by the pharmacy;
     (f) Written policies regarding the qualifications of and training for jail personnel regarding all aspects of medication services provided including, but not limited to, nonpractitioner jail personnel authorized to deliver and administer prescription and nonprescription medications under section 4 of this act;
     (g) Provisions for providing prescribed medication to inmates upon their release or transfer as necessary;
     (h) Maintenance of a medication storage and delivery system, which ensures that all medications are appropriately secured, stored, and regularly inventoried, and prohibits stocks of prescription medication from being maintained within a jail without an on-site pharmacy, except for the storage of medications to be delivered to a specific inmate as directed by a licensed practitioner;
     (i) Ensuring that all medications requiring a prescription are properly dispensed, labeled, packaged, and transferred only in accordance with the direction from the pharmacist and applicable state laws;
     (j) Ensuring the proper disposition of unused medications;
     (k) Maintaining proper and complete inmate files regarding all prescriptions and administration of medications;
     (l) Prohibiting the administration, distribution, delivery, or dispensing of medication by inmates;
     (m) Policies and procedures regarding nonprescription medications, including how they are to be made available;
     (n) Policies regarding inmate self-administration of prescription and nonprescription medications and safeguards for preventing potential abuse;
     (o) Preventing the unauthorized use of medications by anyone other than the intended patient;
     (p) Providing for the routine review and renewal of medication orders by a licensed practitioner with prescriptive authority to ensure patient safety and appropriateness of medication;
     (q) Providing for the right of an individual to refuse medication, except as required by court order and of the right to informed consent; and
     (r) Any other policies or procedures deemed applicable by the work group.

NEW SECTION.  Sec. 2   A new section is added to chapter 18.64 RCW to read as follows:
     Nothing in this chapter or in any provision of law shall be interpreted to invest the board with the authority to regulate or establish standards regarding a jail as defined in RCW 70.48.020 that does not operate, in whole or in part, a pharmacy or a correctional pharmacy. This section does not limit the board's authority to regulate a pharmacist that has entered into an agreement with a jail for the provision of pharmaceutical services.

Sec. 3   RCW 70.48.020 and 1987 c 462 s 6 are each amended to read as follows:
     As used in this chapter the words and phrases in this section shall have the meanings indicated unless the context clearly requires otherwise.
     (1) "Holding facility" means a facility operated by a governing unit primarily designed, staffed, and used for the temporary housing of adult persons charged with a criminal offense prior to trial or sentencing and for the temporary housing of such persons during or after trial and/or sentencing, but in no instance shall the housing exceed thirty days.
     (2) "Detention facility" means a facility operated by a governing unit primarily designed, staffed, and used for the temporary housing of adult persons charged with a criminal offense prior to trial or sentencing and for the housing of adult persons for purposes of punishment and correction after sentencing or persons serving terms not to exceed ninety days.
     (3) "Special detention facility" means a minimum security facility operated by a governing unit primarily designed, staffed, and used for the housing of special populations of sentenced persons who do not require the level of security normally provided in detention and correctional facilities including, but not necessarily limited to, persons convicted of offenses under RCW 46.61.502 or 46.61.504.
     (4) "Correctional facility" means a facility operated by a governing unit primarily designed, staffed, and used for the housing of adult persons serving terms not exceeding one year for the purposes of punishment, correction, and rehabilitation following conviction of a criminal offense.
     (5) "Jail" means any holding, detention, special detention, or correctional facility as defined in this section.
     (6) "Health care" means preventive, diagnostic, and rehabilitative services provided by licensed health care professionals and/or facilities; such care to include providing prescription drugs where indicated.
     (7) "Governing unit" means the city and/or county or any combinations of cities and/or counties responsible for the operation, supervision, and maintenance of a jail.
     (8) "Major urban" means a county or combination of counties which has a city having a population greater than twenty-six thousand based on the 1978 projections of the office of financial management.
     (9) "Medium urban" means a county or combination of counties which has a city having a population equal to or greater than ten thousand but less than twenty-six thousand based on the 1978 projections of the office of financial management.
     (10) "Rural" means a county or combination of counties which has a city having a population less than ten thousand based on the 1978 projections of the office of financial management.
     (11) "Office" means the office of financial management.
     (12) "Medication assistance" means assistance rendered by nonpractitioner jail personnel to an inmate residing in a jail to facilitate the individual's self-administration of a legend drug or controlled substance or nonprescription medication. "Medication assistance" includes reminding or coaching the individual, handing the medication container to the individual, opening the individual's medication container, using an enabler, or placing the medication in the individual's hand.
     (13) "Practitioner" has the same meaning as provided in RCW 69.41.010.
     (14) "Nonpractitioner jail personnel" means appropriately trained staff who are authorized to manage, deliver, or administer prescription and nonprescription medication under section 4 of this act.
     (15) "Administration" means the direct application of a drug whether by ingestion or inhalation, to the body of an inmate by a practitioner or nonpractitioner jail personnel.
     (16) "Drug" and "legend drug" have the same meanings as provided in RCW 69.41.010.
     (17) "Medication" means a drug, legend drug, or controlled substance requiring a prescription or an over-the-counter or nonprescription drug.
     (18) "Deliver" or "delivery" means the actual, constructive, or attempted transfer from one person to another of medication whether or not there is an agency relationship.

NEW SECTION.  Sec. 4   A new section is added to chapter 70.48 RCW to read as follows:
     Jails may provide for the delivery and administration of medications and medication assistance for inmates in their custody by nonpractitioner jail personnel, subject to the following conditions:
     (1) The jail administrator or his or her designee, or chief law enforcement executive or his or her designee, shall enter into an agreement between the jail and a licensed pharmacist, pharmacy, or other licensed practitioner or health care facility to ensure access to pharmaceutical services on a twenty-four hour a day basis, including consultation and dispensing services.
     (2) The jail administrator or chief law enforcement executive shall adopt policies which address the designation and training of nonpractitioner jail personnel who may deliver and administer medications or provide medication assistance to inmates as provided in this chapter. The policies must address the administration of prescriptions from licensed practitioners prescribing within the scope of their prescriptive authority, the identification of medication to be delivered and administered or administered through medication assistance, the means of securing medication with attention to the safeguarding of legend drugs, and the means of maintaining a record of the delivery, administration, self-administration, or medication assistance of all medication. The jail administrator or chief law enforcement executive shall designate a physician licensed under chapter 18.71 RCW, or a registered nurse or advanced registered nurse practitioner licensed under chapter 18.79 RCW, to train the designated nonpractitioner jail personnel in proper medication procedures and monitor their compliance with the procedures.
     (3) The jail administrator or chief law enforcement executive shall consult with one or more pharmacists, and one or more licensed physicians or nurses, in the course of developing the policies described in subsections (1) and (2) of this section. A jail shall provide the Washington association of sheriffs and police chiefs with a copy of the jail's current policies regarding medication management.
     (4) The practitioner or nonpractitioner jail personnel delivering, administering, or providing medication assistance is in receipt of (a) for prescription drugs, a written, current, and unexpired prescription, and instructions for administration from a licensed practitioner prescribing within the scope of his or her prescriptive authority for administration of the prescription drug; (b) for nonprescription drugs, a written, current, and unexpired instruction from a licensed practitioner regarding the administration of the nonprescription drug; and (c) for minors under the age of eighteen, a written, current consent from the minor's parent, legal guardian, or custodian consenting to the administration of the medication.
     (5) Nonpractitioner jail personnel may help in the preparation of legend drugs or controlled substances for self-administration where a practitioner has determined and communicated orally or by written direction that the medication preparation assistance is necessary and appropriate. Medication assistance shall not include assistance with intravenous medications or injectable medications.
     (6) Nonpractitioner jail personnel shall not include inmates.
     (7) All medication is delivered and administered and all medication assistance is provided by a practitioner or nonpractitioner jail personnel pursuant to the policies adopted in this section, and in compliance with the prescription of a practitioner prescribing within the scope of his or her prescriptive authority, or the written instructions as provided in this section.
     (8) The jail administrator or the chief law enforcement executive shall ensure that all nonpractitioner jail personnel authorized to deliver, administer, and provide medication assistance are trained pursuant to the policies adopted in this section prior to being permitted to deliver, administer, or provide medication assistance to an inmate.

NEW SECTION.  Sec. 5   The department of health shall annually review the medication practices of five jails that provide for the delivery and administration of medications to inmates in their custody by nonpractitioner jail personnel. The review shall assess whether the jails are in compliance with sections 3 and 4 of this act. To the extent that a jail is found not in compliance, the department shall provide technical assistance to assist the jail in resolving any areas of noncompliance.

NEW SECTION.  Sec. 6   If specific funding for the purposes of section 1 of this act, referencing section 1 of this act by bill or chapter number and section number, is not provided by June 30, 2009, in the omnibus appropriations act, section 1 of this act is null and void.