BILL REQ. #:  S-3262.1 

Read first time 01/13/14.   Referred to Committee on Health Care .

     AN ACT Relating to creation of a quality improvement program for the licensees of the medical quality assurance commission; amending RCW 18.71.010; and adding new sections to chapter 18.71 RCW.

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

Sec. 1   RCW 18.71.010 and 1994 sp.s. c 9 s 302 are each amended to read as follows:
     The following terms used in this chapter shall have the meanings set forth in this section unless the context clearly indicates otherwise:
     (1) "Commission" means the Washington state medical quality assurance commission.
     (2) "Physician" means a person licensed under this chapter.
     (3) "Practitioner" means either a physician or physician assistant licensed under chapter 18.71A RCW.
     (4) "Quality improvement program" means a program that seeks to educate and improve practitioner proficiency with regard to quality of care, professional standards, ethical guidelines, and other practice standard issues established by the commission pursuant to sections 2 through 8 of this act. The quality improvement program consists of multiple nondisciplinary and nonreportable tools for use by the commission at its discretion to resolve issues relating to medical practice.
     (5) "Secretary" means the secretary of health.
     (((3))) (6) "Resident physician" means an individual who has graduated from a school of medicine which meets the requirements set forth in RCW 18.71.055 and is serving a period of postgraduate clinical medical training sponsored by a college or university in this state or by a hospital accredited by this state. For purposes of this chapter, the term shall include individuals designated as intern or medical fellow.
     (((4))) (7) "Emergency medical care" or "emergency medical service" has the same meaning as in chapter 18.73 RCW.

NEW SECTION.  Sec. 2   The legislature considers physicians and physician assistants as lifelong learners. The legislature further recognizes the nature of this learning, practice correction, and practice improvement typically occurs in an environment that is conducive to learning but not without consequence. This learning or guidance occurs at the direction of more learned peers. Historically, this would occur through the actions of professional associations intended to maintain and improve levels of competency through instruction and guidance. It was through this process that senior members of the association identified and addressed potentially harmful practice deficits before these deficits developed into habits that could harm the patient and by extension the profession. As not all licensed practitioners in the state of Washington are members of professional associations, but all medical practitioners are licensed by the commission, it is appropriate that the commission fulfill the role of providing practice correction to those practitioners in need.

NEW SECTION.  Sec. 3   (1) The commission shall establish a quality improvement program for the purposes of addressing deficits or concerns in the practice of its licensees which are not unprofessional conduct as set forth in RCW 18.130.180 and which do not pose a threat to the safety of patients. The goal of the program is to improve the care of practitioners in a nonpunitive, confidential environment that will result in safer and higher quality care to the citizens of this state. The quality improvement program is educational and nondisciplinary. However, the commission may initiate one or more elements of the quality improvement program with a licensee at any time, including during the complaint process prior to the commission filing charges or allegations against a respondent.
     (2) Notwithstanding any other provision of law, a meeting of the commission, a committee of the commission, or a review panel for the purpose of discussing or adopting a nondisciplinary resolution authorized by this section is not subject to the administrative procedure act, chapter 34.05 RCW, and amendments thereto, and is not subject to the open public meetings act as provided in chapter 42.30 RCW, and amendments thereto.
     (3) A nondisciplinary resolution authorized by this section and all entity records and all findings pursuant to sections 4 through 8 of this act are not subject to disclosure pursuant to chapter 42.56 RCW, and are not admissible in any civil, criminal, or administrative action, except that such resolution is admissible in any disciplinary proceeding by the commission.
     (4) A nondisciplinary resolution authorized by this section is not a disciplinary action or other order or adjudication. No failure to adhere to the applicable standard of care or violation of the Washington medical practice act may be implied by participation in the quality improvement program or the adoption of a nondisciplinary resolution.
     (5) The commission may initiate one or more elements of the quality improvement program with a licensee through the formal complaint process, through the investigative process, or concerns shared informally with the commission by peers, employers, or other concerned parties associated with the licensee.

NEW SECTION.  Sec. 4   (1) The establishment of the quality improvement program authorizes the commission to perform any or all of the following in the effort of executing the program:
     (a) Entering into relationships supportive of the quality improvement program with professionals who provide the following services: Evaluation, education, or quality care improvement;
     (b) Receiving and assessing reports from any source raising issues with a physician's or physician assistant's care or conduct that may need improvement;
     (c) Intervening in cases of questionable behavior or care, or in cases where there is reasonable cause to suspect there is a quality of care or behavior issue but not unprofessional conduct as set forth in RCW 18.130.180;
     (d) Upon reasonable cause, referring physicians or physician assistants for evaluation, education, or quality improvement;
     (e) Monitoring the education and quality improvement of physicians and physician assistants through meetings with the practitioner and individuals assisting the practitioner pursuant to this section;
     (f) Providing monitoring and continuing rehabilitative support of physicians and physician assistants;
     (g) Performing such other activities as agreed upon by the commission and the practitioner; and
     (h) Providing prevention, education, and continuing education, where appropriate.
     (2) The commission shall adopt rules necessary to implement this section.

NEW SECTION.  Sec. 5   (1) The commission may issue and establish the terms of a professional development plan to resolve a concern, complaint, or investigation of a complaint received by the commission relating to practitioners licensed under chapter 18.71 or 18.71A RCW.
     (2) A professional development plan may not contain a provision that:
     (a) Revokes, suspends, limits, or restricts a person's license or other authorization to practice medicine; or
     (b) Assesses an administrative penalty against a person.
     (3) A professional development plan may not be imposed to resolve a complaint:
     (a) Concerning:
     (i) A patient death;
     (ii) The commission of a felony; or
     (iii) A matter in which the physician engaged in inappropriate sexual behavior or contact with a patient or became financially or personally involved with a patient in an inappropriate manner; or
     (b) In which the appropriate resolution may involve a restriction on the manner in which a license holder practices medicine.
     (4) The commission may only issue a professional development plan to resolve a complaint against a license holder if the license holder has not previously entered into a professional development plan within the last five years.
     (5) The license holder participating in a professional development plan is responsible for the costs of administering this plan.

NEW SECTION.  Sec. 6   (1) The commission may issue a letter of guidance to resolve a concern, complaint, or investigation of a complaint received by the commission relating to practitioners licensed under chapter 18.71 or 18.71A RCW. The letter of guidance may detail alleged areas of concern relating to medical practice of a licensee and possible remedies the licensee may undertake to educate themselves on the subject.
     (2) The letter of guidance does not represent a disciplinary finding of the commission and may not be used as evidence in any civil or malpractice proceedings.
     (3) The commission may use the letter of guidance in administrative matters while carrying out its statutory duties.

NEW SECTION.  Sec. 7   (1) The commission may compel an informal interview to resolve a concern, complaint, or investigation of a complaint received by the commission relating to practitioners licensed under chapter 18.71 or 18.71A RCW.
     (2) A commissioner and a commission medical consultant shall attend the informal interview.
     (3) The purpose of the informal interview is to conduct a candid discussion between medical professionals regarding a specific area of practice or situation of concern relating to practice.
     (4) The licensee may choose to attend the informal interview with legal representation.
     (5) An informal interview does not preclude the commission from proceeding with further investigation and disciplinary actions.

NEW SECTION.  Sec. 8   (1) The commission may compel a quality assessment to resolve a concern, complaint, or investigation of a complaint received by the commission relating to practitioners licensed under chapter 18.71 or 18.71A RCW.
     (2) The quality assessment may be conducted at the direction of the commission with a commission approved assessment entity.
     (3) The quality assessment may be conducted in cooperation with the employer of the licensee and any data said employer may choose to share.
     (4) The employer of the licensee may not use the quality assessment or its results to initiate discipline either internally or with the commission.
     (5) The results of the quality assessment are confidential and not subject to disclosure.
     (6) Elements of the quality assessment may consist of, but are not limited to, the following:
     (a) 360 evaluation;
     (b) Physical evaluation that includes tests for hearing, vision, and dexterity;
     (c) Mental evaluation that includes cognitive testing;
     (d) Practice review or evaluation.

NEW SECTION.  Sec. 9   If any provision of this act or its application to any person or circumstance is held invalid, the remainder of the act or the application of the provision to other persons or circumstances is not affected.

NEW SECTION.  Sec. 10   Sections 2 through 8 of this act are each added to chapter 18.71 RCW.