BILL REQ. #: H-3161.1
| State of Washington | 62nd Legislature | 2012 Regular Session |
Prefiled 01/05/12. Read first time 01/09/12. Referred to Committee on Health Care & Wellness.
AN ACT Relating to dental practitioners; amending RCW 18.32.030, 18.32.0351, 18.120.020, 18.130.040, 18.260.010, 18.260.040, 18.260.070, 18.260.080, and 69.41.010; reenacting and amending RCW 69.41.030; adding a new chapter to Title 18 RCW; creating a new section; and providing an effective date.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
NEW SECTION. Sec. 1 The definitions in this section apply
throughout this chapter unless the context clearly requires otherwise.
(1) "Committee" means the dental hygiene examining committee
established in chapter 18.29 RCW.
(2) "Dental hygiene practitioner" means a person licensed under
this chapter who provides dental therapy pursuant to a written practice
plan contract with a dentist.
(3) "Dental practitioner" means a person licensed under this
chapter who provides dental therapy under the off-site supervision of
a dentist pursuant to a written practice plan contract with a dentist.
(4) "Dental therapy" means the services and procedures specified in
section 4 of this act.
(5) "Dentist" means a person licensed to practice dentistry under
chapter 18.32 RCW.
(6) "Department" means the department of health.
(7) "Off-site supervision of a dentist" means supervision that does
not require the dentist to be physically present or to personally
examine or diagnose the patient.
(8) "Secretary" means the secretary of health.
(9) "Supervision of a dentist" means that a supervising dentist:
(a) Has personally examined and diagnosed the patient and has
personally authorized the procedures to be performed;
(b) Is continuously on-site while the procedure in question is
being performed; and
(c) Is capable of responding immediately in the event of an
emergency.
NEW SECTION. Sec. 2 No person may practice dental therapy or
represent himself or herself as a dental practitioner or a dental
hygiene practitioner without being licensed by the department under
this chapter.
NEW SECTION. Sec. 3 (1) The department shall issue a license to
practice as a dental practitioner to any applicant who:
(a) Pays any applicable fees established by the secretary under RCW
43.70.110 and 43.70.250;
(b) Submits, on forms provided by the secretary, the applicant's
name, address, and other applicable information as determined by the
secretary; and
(c) Demonstrates that the following requirements have been met:
(i) Possession of a high school diploma or equivalent;
(ii) Successful completion of a dental health aide therapist
education program approved by the secretary; and
(iii) Completion of a preceptorship of at least four hundred hours
under the supervision of a dentist.
(2) The department shall issue a license to practice as a dental
hygiene practitioner to any applicant who:
(a) Pays any applicable fees established by the secretary under RCW
43.70.110 and 43.70.250;
(b) Submits, on forms provided by the secretary, the applicant's
name, address, and other applicable information as determined by the
secretary; and
(c) Demonstrates that the following requirements have been met:
(i) Possession of a license in good standing as a dental hygienist
under chapter 18.29 RCW;
(ii) Successful completion of a post-baccalaureate advanced dental
hygiene therapy education program at an institution accredited by the
American dental association commission on dental accreditation or other
national accreditation organization approved by the committee;
(iii) Completion of two hundred fifty hours of advanced dental
therapy clinical practice under the supervision of a dentist; and
(iv) Passage of an examination approved by the committee.
NEW SECTION. Sec. 4 (1) Subject to the limitations in this
section and section 5 of this act, a dental practitioner may provide
the following services and procedures:
(a) Oral health instruction and disease prevention education,
including nutritional counseling and dietary analysis;
(b) Preliminary charting of the oral cavity;
(c) Making radiographs;
(d) Mechanical polishing;
(e) Application of topical preventative or prophylactic agents,
including fluoride varnishes and pit and fissure sealants;
(f) Pulp vitality testing;
(g) Application of desensitizing medication or resin;
(h) Fabrication of athletic mouth guards;
(i) Placement of temporary restorations;
(j) Fabrication of soft occlusal guards;
(k) Tissue conditioning and soft reline;
(l) Atraumatic restorative therapy;
(m) Dressing changes;
(n) Tooth reimplantation;
(o) Administration of local anesthetic;
(p) Administration of nitrous oxide;
(q) Emergency palliative treatment of dental pain;
(r) The placement and removal of space maintainers;
(s) Cavity preparation;
(t) Restoration of primary and permanent teeth;
(u) Placement of temporary crowns;
(v) Preparation and placement of preformed crowns;
(w) Pulpotomies on primary teeth;
(x) Indirect and direct pulp capping on primary and permanent
teeth;
(y) Stabilization of reimplanted teeth;
(z) Extractions of primary teeth;
(aa) Suture removal;
(bb) Brush biopsies;
(cc) Repair of defective prosthetic devices;
(dd) Recementing of permanent crowns;
(ee) Oral evaluation and assessment of dental disease and the
formulation of an individualized treatment plan;
(ff) The supervision of expanded function dental auxiliaries and
dental assistants. A dental practitioner or dental hygiene
practitioner may supervise no more than a total of four expanded
function dental auxiliaries and dental assistants in any one practice
setting. A dental practitioner or dental hygiene practitioner may not
supervise an expanded function dental auxiliary or dental assistant
with respect to tasks that the dental practitioner or dental hygiene
practitioner is not authorized to perform;
(gg) Nonsurgical extractions of periodontally diseased permanent
teeth with tooth mobility of plus 3 to plus 4 if the teeth are not
unerupted, are not impacted, are not fractured, and do not need to be
sectioned for removal; and
(hh) The dispensation and administration of the following drugs:
Analgesics, anti-inflammatories, preventive medicaments, and
antibiotics.
(2) Subject to the limitations in this section and section 5 of
this act, a dental hygiene practitioner may provide the following
services and procedures:
(a) The services and procedures authorized for dental practitioners
under subsection (1) of this section; and
(b) Any services and procedures within the scope of practice of a
licensed dental hygienist under chapter 18.29 RCW.
NEW SECTION. Sec. 5 (1) A dental practitioner or a dental
hygiene practitioner may only practice dental therapy pursuant to a
written practice plan contract with a dentist. The contract must, at
a minimum, contain the following elements:
(a) Practice settings where services and procedures may be
provided;
(b) Any limitations on the services or procedures the dental
practitioner or dental hygiene practitioner may provide;
(c) Age and procedure-specific practice protocols, including case
selection criteria, assessment guidelines, and imaging frequency;
(d) Procedures for creating and maintaining dental records for
patients treated by the dental practitioner or dental hygiene
practitioner;
(e) A plan to manage medical emergencies in each practice setting
where the dental practitioner or dental hygiene practitioner provides
care;
(f) A quality assurance plan for monitoring care provided by the
dental practitioner or dental hygiene practitioner, including patient
care review, referral follow-up, and a quality assurance chart review;
(g) Protocols for administering and dispensing medications,
including the specific circumstances under which the medications may be
dispensed and administered;
(h) Criteria relating to the provision of care to patients with
specific medical conditions or complex medical histories, including
requirements for consultation prior to the initiation of care; and
(i) Specific written protocols governing situations where the
dental practitioner or dental hygiene practitioner encounters a patient
requiring treatment that exceeds the dental practitioner's or dental
hygiene practitioner's scope of practice or capabilities.
(2)(a) In addition to the elements specified in subsection (1) of
this section, a written practice plan contract with a dental
practitioner must specify the services and procedures the dental
practitioner is authorized to provide.
(b) All of the services and procedures the dental practitioner
provides pursuant to the practice plan contract must be provided under
the off-site supervision of the contracting dentist. The contracting
dentist shall accept responsibility for all services and procedures
authorized and provided by the dental practitioner pursuant to the
practice plan contract.
(c) A contracting dentist who knowingly permits a dental
practitioner to provide a service or procedure that is not authorized
in the practice plan contract, or any dental practitioner who provides
a service or procedure that is not authorized in the practice plan
contract, commits unprofessional conduct for purposes of chapter 18.130
RCW.
(3) A dentist who enters into a written practice plan contract with
a dental practitioner or dental hygiene practitioner shall:
(a) Directly provide or arrange for another dentist or specialist
to provide any necessary advanced procedures or services needed by the
patient or any treatment that exceeds the dental practitioner's or the
dental hygiene practitioner's scope of practice or capabilities; and
(b) Ensure that he or she or another dentist is available to the
dental practitioner or dental hygiene practitioner for timely
consultation during treatment if needed.
(4) Practice plan contracts must be signed and maintained by both
the contracting dentist and the dental practitioner or dental hygiene
practitioner. The contracts must be submitted to the department on an
annual basis.
(5) A contracting dentist may enter into a practice plan contract
with no more than a total of five dental practitioners and dental
hygiene practitioners at any one time.
NEW SECTION. Sec. 6 Nothing in this chapter prohibits or
affects:
(1) The practice of dental therapy by an individual otherwise
licensed under this title and performing services within his or her
scope of practice;
(2) The practice of dental therapy in the discharge of official
duties on behalf of the United States government, including, but not
limited to, the armed forces, coast guard, public health service,
veterans' bureau, or bureau of Indian affairs;
(3) The practice of dental therapy pursuant to an education program
described in section 3 of this act; or
(4) The practice of dental therapy under the supervision of a
dentist necessary to meet the clinical experience or preceptorship
requirements of section 3 of this act.
NEW SECTION. Sec. 7 Chapter 18.130 RCW governs the unlicensed
practice, the issuance and denial of licenses, and the discipline of
persons licensed under this chapter. The dental quality assurance
commission is the disciplining authority under this chapter.
Sec. 8 RCW 18.32.030 and 2007 c 269 s 15 are each amended to read
as follows:
The following practices, acts, and operations are excepted from the
operation of the provisions of this chapter:
(1) The rendering of dental relief in emergency cases in the
practice of his or her profession by a physician or surgeon, licensed
as such and registered under the laws of this state, unless the
physician or surgeon undertakes to or does reproduce lost parts of the
human teeth in the mouth or to restore or to replace in the human mouth
lost or missing teeth;
(2) The practice of dentistry in the discharge of official duties
by dentists in the United States federal services on federal
reservations, including but not limited to the armed services, coast
guard, public health service, veterans' bureau, or bureau of Indian
affairs;
(3) Dental schools or colleges approved under RCW 18.32.040, and
the practice of dentistry by students in accredited dental schools or
colleges approved by the commission, when acting under the direction
and supervision of Washington state-licensed dental school faculty;
(4) The practice of dentistry by licensed dentists of other states
or countries while appearing as clinicians at meetings of the
Washington state dental association, or component parts thereof, or at
meetings sanctioned by them, or other groups approved by the
commission;
(5) The use of roentgen and other rays for making radiographs or
similar records of dental or oral tissues, under the supervision of a
licensed dentist or physician;
(6) The making, repairing, altering, or supplying of artificial
restorations, substitutions, appliances, or materials for the
correction of disease, loss, deformity, malposition, dislocation,
fracture, injury to the jaws, teeth, lips, gums, cheeks, palate, or
associated tissues or parts; providing the same are made, repaired,
altered, or supplied pursuant to the written instructions and order of
a licensed dentist which may be accompanied by casts, models, or
impressions furnished by the dentist, and the prescriptions shall be
retained and filed for a period of not less than three years and shall
be available to and subject to the examination of the secretary or the
secretary's authorized representatives;
(7) The removal of deposits and stains from the surfaces of the
teeth, the application of topical preventative or prophylactic agents,
and the polishing and smoothing of restorations, when performed or
prescribed by a dental hygienist licensed under the laws of this state;
(8) A qualified and licensed physician and surgeon or osteopathic
physician and surgeon extracting teeth or performing oral surgery
pursuant to the scope of practice under chapter 18.71 or 18.57 RCW;
(9) The performing of dental operations or services by registered
dental assistants and licensed expanded function dental auxiliaries
holding a credential issued under chapter 18.260 RCW when performed
under the supervision of a licensed dentist, by dental practitioners
and dental hygiene practitioners licensed under chapter 18.-- RCW (the
new chapter created in section 18 of this act), or by other persons not
licensed under this chapter if the person is licensed pursuant to
chapter 18.29, 18.57, 18.71, or 18.79 RCW as it applies to registered
nurses and advanced registered nurse practitioners, each while acting
within the scope of the person's permitted practice under the person's
license: PROVIDED HOWEVER, That such persons shall in no event perform
the following dental operations or services unless permitted to be
performed by the person under this chapter or chapters 18.29, 18.57,
18.71, 18.79 as it applies to registered nurses and advanced registered
nurse practitioners, and 18.260 RCW:
(a) Any removal of or addition to the hard or soft tissue of the
oral cavity;
(b) Any diagnosis of or prescription for treatment of disease,
pain, deformity, deficiency, injury, or physical condition of the human
teeth or jaws, or adjacent structure;
(c) Any administration of general or injected local anaesthetic of
any nature in connection with a dental operation, including intravenous
sedation;
(d) Any oral prophylaxis;
(e) The taking of any impressions of the teeth or jaw or the
relationships of the teeth or jaws, for the purpose of fabricating any
intra-oral restoration, appliance, or prosthesis.
Sec. 9 RCW 18.32.0351 and 2007 c 269 s 16 are each amended to
read as follows:
The Washington state dental quality assurance commission is
established, consisting of ((sixteen)) eighteen members each appointed
by the governor to a four-year term. No member may serve more than two
consecutive full terms. In appointing the initial members of the
commission, it is the intent of the legislature that, to the extent
possible, members of the previous boards and committees regulating
these professions be appointed to the commission. Members of the
commission hold office until their successors are appointed. The
governor may appoint members of the initial commission to staggered
terms of from one to four years. Thereafter, all members shall be
appointed to full four-year terms. Twelve members of the commission
must be dentists, one member must be a dental practitioner licensed
under chapter 18.-- RCW (the new chapter created in section 18 of this
act), one member must be a dental hygiene practitioner licensed under
chapter 18.-- RCW (the new chapter created in section 18 of this act),
two members must be expanded function dental auxiliaries licensed under
chapter 18.260 RCW, and two members must be public members.
Sec. 10 RCW 18.120.020 and 2010 c 286 s 14 are each amended to
read as follows:
The definitions in this section apply throughout this chapter
unless the context clearly requires otherwise.
(1) "Applicant group" includes any health professional group or
organization, any individual, or any other interested party which
proposes that any health professional group not presently regulated be
regulated or which proposes to substantially increase the scope of
practice of the profession.
(2) "Certificate" and "certification" mean a voluntary process by
which a statutory regulatory entity grants recognition to an individual
who (a) has met certain prerequisite qualifications specified by that
regulatory entity, and (b) may assume or use "certified" in the title
or designation to perform prescribed health professional tasks.
(3) "Grandfather clause" means a provision in a regulatory statute
applicable to practitioners actively engaged in the regulated health
profession prior to the effective date of the regulatory statute which
exempts the practitioners from meeting the prerequisite qualifications
set forth in the regulatory statute to perform prescribed occupational
tasks.
(4) "Health professions" means and includes the following health
and health-related licensed or regulated professions and occupations:
Podiatric medicine and surgery under chapter 18.22 RCW; chiropractic
under chapter 18.25 RCW; dental hygiene under chapter 18.29 RCW;
dentistry under chapter 18.32 RCW; denturism under chapter 18.30 RCW;
dispensing opticians under chapter 18.34 RCW; hearing instruments under
chapter 18.35 RCW; naturopaths under chapter 18.36A RCW; embalming and
funeral directing under chapter 18.39 RCW; midwifery under chapter
18.50 RCW; nursing home administration under chapter 18.52 RCW;
optometry under chapters 18.53 and 18.54 RCW; ocularists under chapter
18.55 RCW; osteopathic medicine and surgery under chapters 18.57 and
18.57A RCW; pharmacy under chapters 18.64 and 18.64A RCW; medicine
under chapters 18.71 and 18.71A RCW; emergency medicine under chapter
18.73 RCW; physical therapy under chapter 18.74 RCW; practical nurses
under chapter 18.79 RCW; psychologists under chapter 18.83 RCW;
registered nurses under chapter 18.79 RCW; occupational therapists
licensed under chapter 18.59 RCW; respiratory care practitioners
licensed under chapter 18.89 RCW; veterinarians and veterinary
technicians under chapter 18.92 RCW; health care assistants under
chapter 18.135 RCW; massage practitioners under chapter 18.108 RCW;
East Asian medicine practitioners licensed under chapter 18.06 RCW;
persons registered under chapter 18.19 RCW; persons licensed as mental
health counselors, marriage and family therapists, and social workers
under chapter 18.225 RCW; dietitians and nutritionists certified by
chapter 18.138 RCW; radiologic technicians under chapter 18.84 RCW;
dental practitioners and dental hygiene practitioners licensed under
chapter 18.--- RCW (the new chapter created in section 18 of this act);
and nursing assistants registered or certified under chapter 18.88A
RCW.
(5) "Inspection" means the periodic examination of practitioners by
a state agency in order to ascertain whether the practitioners'
occupation is being carried out in a fashion consistent with the public
health, safety, and welfare.
(6) "Legislative committees of reference" means the standing
legislative committees designated by the respective rules committees of
the senate and house of representatives to consider proposed
legislation to regulate health professions not previously regulated.
(7) "License," "licensing," and "licensure" mean permission to
engage in a health profession which would otherwise be unlawful in the
state in the absence of the permission. A license is granted to those
individuals who meet prerequisite qualifications to perform prescribed
health professional tasks and for the use of a particular title.
(8) "Professional license" means an individual, nontransferable
authorization to carry on a health activity based on qualifications
which include: (a) Graduation from an accredited or approved program,
and (b) acceptable performance on a qualifying examination or series of
examinations.
(9) "Practitioner" means an individual who (a) has achieved
knowledge and skill by practice, and (b) is actively engaged in a
specified health profession.
(10) "Public member" means an individual who is not, and never was,
a member of the health profession being regulated or the spouse of a
member, or an individual who does not have and never has had a material
financial interest in either the rendering of the health professional
service being regulated or an activity directly related to the
profession being regulated.
(11) "Registration" means the formal notification which, prior to
rendering services, a practitioner shall submit to a state agency
setting forth the name and address of the practitioner; the location,
nature and operation of the health activity to be practiced; and, if
required by the regulatory entity, a description of the service to be
provided.
(12) "Regulatory entity" means any board, commission, agency,
division, or other unit or subunit of state government which regulates
one or more professions, occupations, industries, businesses, or other
endeavors in this state.
(13) "State agency" includes every state office, department, board,
commission, regulatory entity, and agency of the state, and, where
provided by law, programs and activities involving less than the full
responsibility of a state agency.
Sec. 11 RCW 18.130.040 and 2011 c 41 s 11 are each amended to
read as follows:
(1) This chapter applies only to the secretary and the boards and
commissions having jurisdiction in relation to the professions licensed
under the chapters specified in this section. This chapter does not
apply to any business or profession not licensed under the chapters
specified in this section.
(2)(a) The secretary has authority under this chapter in relation
to the following professions:
(i) Dispensing opticians licensed and designated apprentices under
chapter 18.34 RCW;
(ii) Midwives licensed under chapter 18.50 RCW;
(iii) Ocularists licensed under chapter 18.55 RCW;
(iv) Massage operators and businesses licensed under chapter 18.108
RCW;
(v) Dental hygienists licensed under chapter 18.29 RCW;
(vi) East Asian medicine practitioners licensed under chapter 18.06
RCW;
(vii) Radiologic technologists certified and X-ray technicians
registered under chapter 18.84 RCW;
(viii) Respiratory care practitioners licensed under chapter 18.89
RCW;
(ix) Hypnotherapists and agency affiliated counselors registered
and advisors and counselors certified under chapter 18.19 RCW;
(x) Persons licensed as mental health counselors, mental health
counselor associates, marriage and family therapists, marriage and
family therapist associates, social workers, social work associates--advanced, and social work associates -- independent clinical under
chapter 18.225 RCW;
(xi) Persons registered as nursing pool operators under chapter
18.52C RCW;
(xii) Nursing assistants registered or certified under chapter
18.88A RCW;
(xiii) Health care assistants certified under chapter 18.135 RCW;
(xiv) Dietitians and nutritionists certified under chapter 18.138
RCW;
(xv) Chemical dependency professionals and chemical dependency
professional trainees certified under chapter 18.205 RCW;
(xvi) Sex offender treatment providers and certified affiliate sex
offender treatment providers certified under chapter 18.155 RCW;
(xvii) Persons licensed and certified under chapter 18.73 RCW or
RCW 18.71.205;
(xviii) Denturists licensed under chapter 18.30 RCW;
(xix) Orthotists and prosthetists licensed under chapter 18.200
RCW;
(xx) Surgical technologists registered under chapter 18.215 RCW;
(xxi) Recreational therapists (([under chapter 18.230 RCW])) under
chapter 18.230 RCW;
(xxii) Animal massage practitioners certified under chapter 18.240
RCW;
(xxiii) Athletic trainers licensed under chapter 18.250 RCW;
(xxiv) Home care aides certified under chapter 18.88B RCW; and
(xxv) Genetic counselors licensed under chapter 18.290 RCW.
(b) The boards and commissions having authority under this chapter
are as follows:
(i) The podiatric medical board as established in chapter 18.22
RCW;
(ii) The chiropractic quality assurance commission as established
in chapter 18.25 RCW;
(iii) The dental quality assurance commission as established in
chapter 18.32 RCW governing licenses issued under chapter 18.32 RCW,
licenses issued under chapter 18.--- RCW (the new chapter created in
section 18 of this act), and licenses and registrations issued under
chapter 18.260 RCW;
(iv) The board of hearing and speech as established in chapter
18.35 RCW;
(v) The board of examiners for nursing home administrators as
established in chapter 18.52 RCW;
(vi) The optometry board as established in chapter 18.54 RCW
governing licenses issued under chapter 18.53 RCW;
(vii) The board of osteopathic medicine and surgery as established
in chapter 18.57 RCW governing licenses issued under chapters 18.57 and
18.57A RCW;
(viii) The board of pharmacy as established in chapter 18.64 RCW
governing licenses issued under chapters 18.64 and 18.64A RCW;
(ix) The medical quality assurance commission as established in
chapter 18.71 RCW governing licenses and registrations issued under
chapters 18.71 and 18.71A RCW;
(x) The board of physical therapy as established in chapter 18.74
RCW;
(xi) The board of occupational therapy practice as established in
chapter 18.59 RCW;
(xii) The nursing care quality assurance commission as established
in chapter 18.79 RCW governing licenses and registrations issued under
that chapter;
(xiii) The examining board of psychology and its disciplinary
committee as established in chapter 18.83 RCW;
(xiv) The veterinary board of governors as established in chapter
18.92 RCW; and
(xv) The board of naturopathy established in chapter 18.36A RCW.
(3) In addition to the authority to discipline license holders, the
disciplining authority has the authority to grant or deny licenses.
The disciplining authority may also grant a license subject to
conditions.
(4) All disciplining authorities shall adopt procedures to ensure
substantially consistent application of this chapter, the Uniform
Disciplinary Act, among the disciplining authorities listed in
subsection (2) of this section.
Sec. 12 RCW 18.260.010 and 2007 c 269 s 1 are each amended to
read as follows:
The definitions in this section apply throughout this chapter
unless the context clearly requires otherwise.
(1) "Close supervision" means that a supervising dentist, dental
practitioner, or dental hygiene practitioner whose patient is being
treated has personally diagnosed the condition to be treated and has
personally authorized the procedures to be performed. The supervising
dentist, dental practitioner, or dental hygiene practitioner is
continuously on-site and physically present in the treatment facility
while the procedures are performed by the assistive personnel and
capable of responding immediately in the event of an emergency. The
term does not require a supervising dentist, dental practitioner, or
dental hygiene practitioner to be physically present in the operatory.
(2) "Commission" means the Washington state dental quality
assurance commission created in chapter 18.32 RCW.
(3) "Dental assistant" means a person who is registered by the
commission to provide supportive services to a licensed dentist to the
extent provided in this chapter and under the close supervision of a
dentist.
(4) "Dental hygiene practitioner" means an individual who holds a
license to practice as a dental hygiene practitioner under chapter
18.--- RCW (the new chapter created in section 18 of this act).
(5) "Dental practitioner" means an individual who holds a license
to practice as a dental practitioner under chapter 18.--- RCW (the new
chapter created in section 18 of this act).
(6) "Dentist" means an individual who holds a license to practice
dentistry under chapter 18.32 RCW.
(((5))) (7) "Department" means the department of health.
(((6))) (8) "Expanded function dental auxiliary" means a person who
is licensed by the commission to provide supportive services to a
licensed dentist, dental practitioner, or dental hygiene practitioner
to the extent provided in this chapter and under the specified level of
supervision of a dentist, dental practitioner, or dental hygiene
practitioner.
(((7))) (9) "General supervision" means that a supervising dentist,
dental practitioner, or dental hygiene practitioner has examined and
diagnosed the patient and provided subsequent instructions to be
performed by the assistive personnel, but does not require that the
dentist, dental practitioner, or dental hygiene practitioner be
physically present in the treatment facility.
(((8))) (10) "Secretary" means the secretary of health.
(((9))) (11) "Supervising dental hygiene practitioner" means a
dental hygiene practitioner licensed under chapter 18.--- RCW (the new
chapter created in section 18 of this act) who is responsible for
providing the appropriate level of supervision for dental assistants
and expanded function dental auxiliaries.
(12) "Supervising dental practitioner" means a dental practitioner
licensed under chapter 18.-- RCW (the new chapter created in section 18
of this act) who is responsible for providing the appropriate level of
supervision for dental assistants and expanded function dental
auxiliaries.
(13) "Supervising dentist" means a dentist licensed under chapter
18.32 RCW that is responsible for providing the appropriate level of
supervision for dental assistants and expanded function dental
auxiliaries.
Sec. 13 RCW 18.260.040 and 2007 c 269 s 5 are each amended to
read as follows:
(1) The commission shall adopt rules relating to the scope of
dental assisting services related to patient care and laboratory duties
that may be performed by dental assistants. All dental services
performed by dental assistants must be performed under the close
supervision of a supervising dentist, a supervising dental
practitioner, or a supervising dental hygiene practitioner as the
dentist, dental practitioner, or dental hygiene practitioner may allow.
(2) In addition to any other limitations established by the
commission, dental assistants may not perform the following procedures:
(a) Any scaling procedure;
(b) Any oral prophylaxis, except coronal polishing;
(c) Administration of any general or local anesthetic, including
intravenous sedation;
(d) Any removal of or addition to the hard or soft tissue of the
oral cavity;
(e) Any diagnosis of or prescription for treatment of disease,
pain, deformity, deficiency, injury, or physical condition of the human
teeth, jaw, or adjacent structures; and
(f) The taking of any impressions of the teeth or jaw or the
relationships of the teeth or jaws, for the purpose of fabricating any
intra-oral restoration, appliance, or prosthesis.
(3) A dentist, dental practitioner, or dental hygiene practitioner
may not assign a dental assistant to perform duties until the dental
assistant has demonstrated skills necessary to perform competently all
assigned duties and responsibilities.
Sec. 14 RCW 18.260.070 and 2007 c 269 s 6 are each amended to
read as follows:
(1) The commission shall adopt rules relating to the scope of
expanded function dental auxiliary services related to patient care and
laboratory duties that may be performed by expanded function dental
auxiliaries.
(2) The scope of expanded function dental auxiliary services that
the commission identifies in subsection (1) of this section includes:
(a) In addition to the dental assisting services that a dental
assistant may perform under the close supervision of a supervising
dentist, a supervising dental practitioner, or a supervising dental
hygiene practitioner, the performance of the following services under
the general supervision of a supervising dentist, a supervising dental
practitioner, or a supervising dental hygiene practitioner as the
dentist, dental practitioner, or dental hygiene practitioner may allow:
(i) Performing coronal polishing;
(ii) Giving fluoride treatments;
(iii) Applying sealants;
(iv) Placing dental x-ray film and exposing and developing the
films;
(v) Giving patient oral health instruction; and
(b) Notwithstanding any prohibitions in RCW 18.260.040, the
performance of the following services under the close supervision of a
supervising dentist, a supervising dental practitioner, or a
supervising dental hygiene practitioner as the dentist, dental
practitioner, or dental hygiene practitioner may allow:
(i) Placing and carving direct restorations; and
(ii) Taking final impressions.
(3) A dentist, dental practitioner, or dental hygiene practitioner
may not assign an expanded function dental auxiliary to perform
services until the expanded function dental auxiliary has demonstrated
skills necessary to perform competently all assigned duties and
responsibilities.
Sec. 15 RCW 18.260.080 and 2007 c 269 s 7 are each amended to
read as follows:
A supervising dentist, a supervising dental practitioner, or a
supervising dental hygiene practitioner is responsible for:
(1) Maintaining the appropriate level of supervision for dental
assistants and expanded function dental auxiliaries; and
(2) Ensuring that the dental assistants and expanded function
dental auxiliaries that the dentist, dental practitioner, or dental
hygiene practitioner supervises are able to competently perform the
tasks that they are assigned.
Sec. 16 RCW 69.41.010 and 2009 c 549 s 1024 are each amended to
read as follows:
As used in this chapter, the following terms have the meanings
indicated unless the context clearly requires otherwise:
(1) "Administer" means the direct application of a legend drug
whether by injection, inhalation, ingestion, or any other means, to the
body of a patient or research subject by:
(a) A practitioner; or
(b) The patient or research subject at the direction of the
practitioner.
(2) "Community-based care settings" include: Community residential
programs for the developmentally disabled, certified by the department
of social and health services under chapter 71A.12 RCW; adult family
homes licensed under chapter 70.128 RCW; and boarding homes licensed
under chapter 18.20 RCW. Community-based care settings do not include
acute care or skilled nursing facilities.
(3) "Deliver" or "delivery" means the actual, constructive, or
attempted transfer from one person to another of a legend drug, whether
or not there is an agency relationship.
(4) "Department" means the department of health.
(5) "Dispense" means the interpretation of a prescription or order
for a legend drug and, pursuant to that prescription or order, the
proper selection, measuring, compounding, labeling, or packaging
necessary to prepare that prescription or order for delivery.
(6) "Dispenser" means a practitioner who dispenses.
(7) "Distribute" means to deliver other than by administering or
dispensing a legend drug.
(8) "Distributor" means a person who distributes.
(9) "Drug" means:
(a) Substances recognized as drugs in the official United States
pharmacopoeia, official homeopathic pharmacopoeia of the United States,
or official national formulary, or any supplement to any of them;
(b) Substances intended for use in the diagnosis, cure, mitigation,
treatment, or prevention of disease in human beings or animals;
(c) Substances (other than food, minerals or vitamins) intended to
affect the structure or any function of the body of human beings or
animals; and
(d) Substances intended for use as a component of any article
specified in (a), (b), or (c) of this subsection. It does not include
devices or their components, parts, or accessories.
(10) "Electronic communication of prescription information" means
the communication of prescription information by computer, or the
transmission of an exact visual image of a prescription by facsimile,
or other electronic means for original prescription information or
prescription refill information for a legend drug between an authorized
practitioner and a pharmacy or the transfer of prescription information
for a legend drug from one pharmacy to another pharmacy.
(11) "In-home care settings" include an individual's place of
temporary and permanent residence, but does not include acute care or
skilled nursing facilities, and does not include community-based care
settings.
(12) "Legend drugs" means any drugs which are required by state law
or regulation of the state board of pharmacy to be dispensed on
prescription only or are restricted to use by practitioners only.
(13) "Legible prescription" means a prescription or medication
order issued by a practitioner that is capable of being read and
understood by the pharmacist filling the prescription or the nurse or
other practitioner implementing the medication order. A prescription
must be hand printed, typewritten, or electronically generated.
(14) "Medication assistance" means assistance rendered by a
nonpractitioner to an individual residing in a community-based care
setting or in-home care setting to facilitate the individual's self-administration of a legend drug or controlled substance. It 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, and
such other means of medication assistance as defined by rule adopted by
the department. A nonpractitioner 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 such medication preparation assistance is necessary and
appropriate. Medication assistance shall not include assistance with
intravenous medications or injectable medications, except prefilled
insulin syringes.
(15) "Person" means individual, corporation, government or
governmental subdivision or agency, business trust, estate, trust,
partnership or association, or any other legal entity.
(16) "Practitioner" means:
(a) A physician under chapter 18.71 RCW, an osteopathic physician
or an osteopathic physician and surgeon under chapter 18.57 RCW, a
dentist under chapter 18.32 RCW, a podiatric physician and surgeon
under chapter 18.22 RCW, a veterinarian under chapter 18.92 RCW, a
registered nurse, advanced registered nurse practitioner, or licensed
practical nurse under chapter 18.79 RCW, an optometrist under chapter
18.53 RCW who is certified by the optometry board under RCW 18.53.010,
an osteopathic physician assistant under chapter 18.57A RCW, a
physician assistant under chapter 18.71A RCW, a naturopath licensed
under chapter 18.36A RCW, a pharmacist under chapter 18.64 RCW, or,
when acting under the required supervision of a dentist licensed under
chapter 18.32 RCW, a dental hygienist licensed under chapter 18.29 RCW
or a dental hygiene practitioner licensed under chapter 18.--- RCW (the
new chapter created in section 18 of this act), or a dental
practitioner licensed under chapter 18.--- RCW (the new chapter created
in section 18 of this act);
(b) A pharmacy, hospital, or other institution licensed,
registered, or otherwise permitted to distribute, dispense, conduct
research with respect to, or to administer a legend drug in the course
of professional practice or research in this state; and
(c) A physician licensed to practice medicine and surgery or a
physician licensed to practice osteopathic medicine and surgery in any
state, or province of Canada, which shares a common border with the
state of Washington.
(17) "Secretary" means the secretary of health or the secretary's
designee.
Sec. 17 RCW 69.41.030 and 2011 1st sp.s. c 15 s 79 and 2011 c 336
s 837 are each reenacted and amended to read as follows:
(1) It shall be unlawful for any person to sell, deliver, or
possess any legend drug except upon the order or prescription of a
physician under chapter 18.71 RCW, an osteopathic physician and surgeon
under chapter 18.57 RCW, an optometrist licensed under chapter 18.53
RCW who is certified by the optometry board under RCW 18.53.010, a
dentist under chapter 18.32 RCW, a podiatric physician and surgeon
under chapter 18.22 RCW, a veterinarian under chapter 18.92 RCW, a
commissioned medical or dental officer in the United States armed
forces or public health service in the discharge of his or her official
duties, a duly licensed physician or dentist employed by the veterans
administration in the discharge of his or her official duties, a
registered nurse or advanced registered nurse practitioner under
chapter 18.79 RCW when authorized by the nursing care quality assurance
commission, an osteopathic physician assistant under chapter 18.57A RCW
when authorized by the board of osteopathic medicine and surgery, a
physician assistant under chapter 18.71A RCW when authorized by the
medical quality assurance commission, a dental hygiene practitioner or
dental practitioner under chapter 18.--- RCW (the new chapter created
in section 18 of this act) as authorized in section 4 of this act, or
any of the following professionals in any province of Canada that
shares a common border with the state of Washington or in any state of
the United States: A physician licensed to practice medicine and
surgery or a physician licensed to practice osteopathic medicine and
surgery, a dentist licensed to practice dentistry, a podiatric
physician and surgeon licensed to practice podiatric medicine and
surgery, a licensed advanced registered nurse practitioner, or a
veterinarian licensed to practice veterinary medicine: PROVIDED,
HOWEVER, That the above provisions shall not apply to sale, delivery,
or possession by drug wholesalers or drug manufacturers, or their
agents or employees, or to any practitioner acting within the scope of
his or her license, or to a common or contract carrier or warehouse
operator, or any employee thereof, whose possession of any legend drug
is in the usual course of business or employment: PROVIDED FURTHER,
That nothing in this chapter or chapter 18.64 RCW shall prevent a
family planning clinic that is under contract with the health care
authority from selling, delivering, possessing, and dispensing
commercially prepackaged oral contraceptives prescribed by authorized,
licensed health care practitioners.
(2)(a) A violation of this section involving the sale, delivery, or
possession with intent to sell or deliver is a class B felony
punishable according to chapter 9A.20 RCW.
(b) A violation of this section involving possession is a
misdemeanor.
NEW SECTION. Sec. 18 Sections 1 through 7 of this act constitute
a new chapter in Title
NEW SECTION. Sec. 19 The department and the dental quality
assurance commission shall adopt any rules necessary to implement this
act.
NEW SECTION. Sec. 20 Sections 1 through 17 of this act take
effect January 1, 2013.