1256.E AMS HHS S2740.4

EHB 1256 - S COMM AMD

By Committee on Health & Human Services

    Strike everything after the enacting clause and insert the following:

    "Sec. 1.  RCW 18.130.010 and 1991 c 332 s 1 are each amended to read as follows:

    It is the intent of the legislature to strengthen and consolidate disciplinary and licensure procedures for the licensed health and health-related professions and businesses by providing a uniform disciplinary act with standardized procedures for the licensure of health care professionals and the consistent enforcement of laws the purpose of which is to assure the public of the adequacy of professional competence and conduct in the healing arts.

    It is also the intent of the legislature that all health and health-related professions newly credentialed by the state come under the uniform disciplinary act.

    Further, the legislature declares that the addition of public members on all health care boards can give both the state and the public, which it has a statutory responsibility to protect, assurances of accountability and confidence in the various practices of health care.  It is further the intent that this chapter will best be implemented by a uniform and consistently applied disciplinary process.

    Sec. 2.  RCW 18.130.040 and 1992 c 128 s 6 are each amended to read as follows:

    (1) This chapter applies only to the secretary and the boards 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 under chapter 18.34 RCW;

    (ii) Naturopaths licensed under chapter 18.36A RCW;

    (iii) Midwives licensed under chapter 18.50 RCW;

    (iv) Ocularists licensed under chapter 18.55 RCW;

    (v) Massage operators and businesses licensed under chapter 18.108 RCW;

    (vi) Dental hygienists licensed under chapter 18.29 RCW;

    (vii) Acupuncturists certified under chapter 18.06 RCW;

    (viii) Radiologic technologists certified and x-ray technicians registered under chapter 18.84 RCW;

    (ix) Respiratory care practitioners certified under chapter 18.89 RCW;

    (x) Persons registered or certified under chapter 18.19 RCW;

    (xi) Persons registered as nursing pool operators under chapter 18.52C RCW;

    (xii) Nursing assistants registered or certified under chapter ((18.52B)) 18.88A RCW;

    (xiii) Dietitians and nutritionists certified under chapter 18.138 RCW;

    (xiv) Sex offender treatment providers certified under chapter 18.155 RCW; ((and))

    (xv) Persons licensed and certified under chapter 18.73 RCW or RCW 18.71.205; and

(xvi) Health care assistants certified under chapter 18.135 RCW.

    (b) The boards having authority under this chapter are as follows:

    (i) The podiatric medical board as established in chapter 18.22 RCW;

    (ii) The board of chiropractic ((disciplinary board)) as established in chapter ((18.26 RCW governing licenses issued under chapter)) 18.25 RCW;

    (iii) The ((dental disciplinary)) board of dentistry as established in chapter 18.32 RCW;

    (iv) The council on hearing aids as established in chapter 18.35 RCW;

    (v) The board of funeral directors and embalmers as established in chapter 18.39 RCW;

    (vi) The board of examiners for nursing home administrators as established in chapter 18.52 RCW;

    (vii) The optometry board as established in chapter 18.54 RCW governing licenses issued under chapter 18.53 RCW;

    (viii) 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;

    (ix) The ((medical disciplinary)) board of medicine as established in chapter ((18.72)) 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 board of practical nursing as established in chapter 18.78 RCW;

    (xiii) The examining board of psychology and its disciplinary committee as established in chapter 18.83 RCW;

    (xiv) The board of nursing as established in chapter 18.88 RCW; and

    (xv) The veterinary board of governors as established in chapter 18.92 RCW;

(xvi) The board of pharmacy as established in chapter 18.64 RCW governing licenses governed under chapters 18.64 and 18.64A RCW.

    (3) In addition to the authority to discipline license holders, the disciplining authority has the authority to grant or deny licenses based on the conditions and criteria established in this chapter and the chapters specified in subsection (2) of this section.  ((However, the board of chiropractic examiners has authority over issuance and denial of licenses provided for in chapter 18.25 RCW, the board of dental examiners has authority over issuance and denial of licenses provided for in RCW 18.32.040, and the board of medical examiners has authority over issuance and denial of licenses and registrations provided for in chapters 18.71 and 18.71A RCW.))  This chapter also governs any investigation, hearing, or proceeding relating to denial of licensure or issuance of a license conditioned on the applicant's compliance with an order entered pursuant to RCW 18.130.160 by the disciplining authority.

    Sec. 3.  RCW 18.130.050 and 1987 c 150 s 2 are each amended to read as follows:

    The disciplining authority has the following authority:

    (1) To adopt, amend, and rescind such rules as are deemed necessary to carry out this chapter;

    (2) To investigate all complaints or reports of unprofessional conduct as defined in this chapter and to hold hearings as provided in this chapter;

    (3) To issue subpoenas and administer oaths in connection with any investigation, hearing, or proceeding held under this chapter;

    (4) To take or cause depositions to be taken and use other discovery procedures as needed in any investigation, hearing, or proceeding held under this chapter;

    (5) To compel attendance of witnesses at hearings;

    (6) In the course of investigating a complaint or report of unprofessional conduct, to conduct practice reviews;

    (7) To take emergency action ordering summary suspension of a license, or restriction or limitation of the licensee's practice pending proceedings by the disciplining authority;

    (8) To use the office of administrative hearings as authorized in chapter 34.12 RCW to conduct hearings.  However, the disciplining authority shall make the final decision regarding disposition of the license;

    (9) To use individual members of the boards to direct investigations.  However, the member of the board shall not subsequently participate in the hearing of the case;

    (10) To enter into contracts for professional services determined to be necessary for adequate enforcement of this chapter;

    (11) To contract with licensees or other persons or organizations to provide services necessary for the monitoring and supervision of licensees who are placed on probation, whose professional activities are restricted, or who are for any authorized purpose subject to monitoring by the disciplining authority;

    (12) To adopt standards of professional conduct or practice;

    (13) To grant or deny license applications, and in the event of a finding of unprofessional conduct by an applicant or license holder, to impose any sanction against a license applicant or license holder provided by this chapter;

    (14) ((To enter into an assurance of discontinuance in lieu of issuing a statement of charges or conducting a hearing.  The assurance shall consist of a statement of the law in question and an agreement to not violate the stated provision.  The applicant or license holder shall not be required to admit to any violation of the law, nor shall the assurance be construed as such an admission.  Violation of an assurance under this subsection is grounds for disciplinary action;

    (15))) To designate individuals authorized to sign subpoenas and statements of charges;

(15) To establish panels consisting of three or more members of the board to perform any duty or authority within the board's jurisdiction under this chapter;

(16) To review and audit the records of licensed health facilities' or services' quality assurance committee decisions in which a licensee's practice privilege or employment is terminated or restricted.  Each health facility or service shall produce and make accessible to the disciplining authority such records and otherwise reasonably facilitate the review and audit.  The disciplinary authority shall treat such information and records as confidential and use them only for the purpose of licensee discipline.  Information so gained is not subject to disclosure under chapter 42.17 RCW, to discovery or introduction into evidence in any civil action and shall be exempt from public disclosure under chapter 42.17 RCW.

    Sec. 4.  RCW 18.130.060 and 1991 c 3 s 269 are each amended to read as follows:

    In addition to the authority specified in RCW 18.130.050, the secretary has the following additional authority:

    (1) To employ such investigative, administrative, and clerical staff as necessary for the enforcement of this chapter;

    (2) Upon the request of a board, to appoint ((not more than three)) pro tem members for the purpose of participating as members of one or more committees of the board in connection with proceedings specifically identified in the request.  Individuals so appointed must meet the same minimum qualifications as regular members of the board.  While serving as board members pro tem, persons so appointed have all the powers, duties, and immunities, and are entitled to the emoluments, including travel expenses in accordance with RCW 43.03.050 and 43.03.060, of regular members of the board.  The chairperson of a committee shall be a regular member of the board appointed by the board chairperson.  Committees have authority to act as directed by the board with respect to all matters concerning the review, investigation, and adjudication of all complaints, allegations, charges, and matters subject to the jurisdiction of the board.  The authority to act through committees does not restrict the authority of the board to act as a single body at any phase of proceedings within the board's jurisdiction.  Board committees may make interim orders and issue final decisions with respect to matters and cases delegated to the committee by the board.  Final decisions may be appealed as provided in chapter 34.05 RCW, the Administrative Procedure Act;

    (3) To establish fees to be paid for witnesses, expert witnesses, and consultants used in any investigation and to establish fees to witnesses in any agency adjudicative proceeding as authorized by RCW 34.05.446;

    (4) To conduct investigations and practice reviews at the direction of the disciplining authority and to issue subpoenas, administer oaths, and take depositions in the course of conducting those investigations and practice reviews at the direction of the disciplining authority.

    Sec. 5.  RCW 18.130.090 and 1986 c 259 s 6 are each amended to read as follows:

    (((1))) If the disciplining authority determines, upon investigation, that there is reason to believe a violation of RCW 18.130.180 has occurred, a statement of charge or charges shall be prepared and served upon the license holder or applicant at the earliest practical time.  The statement of charge or charges shall be accompanied by a notice that the license holder or applicant may request a hearing to contest the charge or charges.  The license holder or applicant must file a request for hearing with the disciplining authority within twenty days after being served the statement of charges.  ((The failure to request a hearing constitutes a default, whereupon the disciplining authority may enter a decision on the basis of the facts available to it.

    (2) If a hearing is requested, the time of the hearing shall be fixed by the disciplining authority as soon as convenient, but the hearing shall not be held earlier than thirty days after service of the charges upon the license holder or applicant.  A notice of hearing shall be issued at least twenty days prior to the hearing, specifying the time, date, and place of the hearing.  The notice shall also notify the license holder or applicant that a record of the proceeding will be kept, that he or she will have the opportunity to appear personally and to have counsel present, with the right to produce witnesses, who will be subject to cross-examination, and evidence in his or her own behalf, to cross-examine witnesses testifying against him or her, to examine such documentary evidence as may be produced against him or her, to conduct depositions, and to have subpoenas issued by the disciplining authority.))  If the twenty-day limit results in a hardship upon the license holder or applicant, he or she may request for good cause an extension not to exceed sixty additional days.  If the disciplining authority finds that there is good cause, it shall grant the extension.

    Sec. 6.  RCW 18.130.160 and 1986 c 259 s 8 are each amended to read as follows:

    Upon a finding, after hearing, that a license holder or applicant has committed unprofessional conduct or is unable to practice with reasonable skill and safety due to a physical or mental condition, the disciplining authority may issue an order providing for one or any combination of the following:

    (1) Revocation of the license;

    (2) Suspension of the license for a fixed or indefinite term;

    (3) Restriction or limitation of the practice;

    (4) Requiring the satisfactory completion of a specific program of remedial education or treatment;

    (5) The monitoring of the practice by a supervisor approved by the disciplining authority;

    (6) Censure or reprimand;

    (7) Compliance with conditions of probation for a designated period of time;

    (8) Payment of a fine for each violation of this chapter, not to exceed ((one)) five thousand dollars per violation.  Funds received shall be placed in the health professions account;

    (9) Denial of the license request;

    (10) Corrective action;

    (11) Refund of fees billed to and collected from the consumer.

    Any of the actions under this section may be totally or partly stayed by the disciplining authority.  In determining what action is appropriate, the disciplining authority must first consider what sanctions are necessary to protect or compensate the public.  Only after such provisions have been made may the disciplining authority consider and include in the order requirements designed to rehabilitate the license holder or applicant.  All costs associated with compliance with orders issued under this section are the obligation of the license holder or applicant.

The licensee or applicant may enter into a stipulated disposition of charges that includes one or more of the sanctions of this section, but only after a statement of charges has been issued and the licensee has been afforded the opportunity for a hearing and has elected on the record to forego such a hearing.  The stipulation shall either contain one or more specific findings of unprofessional conduct or inability to practice, or a statement by the licensee acknowledging that evidence is sufficient to justify one or more specified findings of unprofessional conduct or inability to practice.  The stipulation entered into pursuant to this subsection shall be considered formal disciplinary action for all purposes.

NEW SECTION. Sec. 7.  A new section is added to chapter 18.130 RCW to read as follows:

    (1) Prior to serving a statement of charges under RCW 18.130.090 or 18.130.170, the disciplinary authority may furnish a statement of allegations to the licensee or applicant along with a detailed summary of the evidence relied upon to establish the allegations and a proposed stipulation for informal resolution of the allegations.  These documents shall be exempt from public disclosure until such time as the allegations are resolved either by stipulation or otherwise.

    (2) The disciplinary authority and the applicant or licensee may stipulate that the allegations may be disposed of informally in accordance with this subsection.  The stipulation shall contain a statement of the facts leading to the filing of the complaint; the act or acts of unprofessional conducted alleged to have been committed or the alleged basis for determining that the applicant or licensee is unable to practice with reasonable skill and safety; a statement that the stipulation is not to be construed as a finding of either unprofessional conduct or inability to practice; an acknowledgement that a finding of unprofessional conduct or inability to practice, if proven, constitutes grounds for discipline under this chapter; and an agreement on the part of the licensee or applicant that the sanctions set forth in RCW 18.130.160, except RCW 18.130.160 (1), (2), (6), and (8), may be imposed as part of the stipulation, except that no fine may be imposed but the licensee or applicant may agree to reimburse the disciplinary authority the costs of investigation and processing the complaint up to an amount not exceeding one thousand dollars per allegation; and an agreement on the part of the disciplinary authority to forego further disciplinary proceedings concerning the allegations.  A stipulation entered into pursuant to this subsection shall not be considered formal disciplinary action.

    (3) If the licensee or applicant declines to agree to disposition of the charges by means of a stipulation pursuant to subsection (2) of this section, the disciplinary authority may proceed to formal disciplinary action pursuant to RCW 18.130.090 or 18.130.170.

    (4) Upon execution of a stipulation under subsection (2) of this section by both the licensee or applicant and the disciplinary authority, the complaint is deemed disposed of and shall become subject to public disclosure on the same basis and to the same extent as other records of the disciplinary authority.  Should the licensee or applicant fail to pay any agreed reimbursement within thirty days of the date specified in the stipulation for payment, the disciplinary authority may seek collection of the amount agreed to be paid in the same manner as enforcement of a fine under RCW 18.130.165.

    Sec. 8.  RCW 18.130.165 and 1987 c 150 s 4 are each amended to read as follows:

    Where an order for payment of a fine is made as a result of a hearing under RCW 18.130.100 or 18.130.190 and timely payment is not made as directed in the final order, the disciplining authority may enforce the order for payment in the superior court in the county in which the hearing was held.  This right of enforcement shall be in addition to any other rights the disciplining authority may have as to any licensee ordered to pay a fine but shall not be construed to limit a licensee's ability to seek judicial review under RCW 18.130.140.

    In any action for enforcement of an order of payment of a fine, the disciplining authority's order is conclusive proof of the validity of the order of payment of a fine and the terms of payment.

    Sec. 9.  RCW 18.130.175 and 1991 c 3 s 270 are each amended to read as follows:

    (1) In lieu of disciplinary action under RCW 18.130.160 and if the disciplining authority determines that the unprofessional conduct may be the result of substance abuse, the disciplining authority may refer the license holder to a voluntary substance abuse monitoring program approved by the disciplining authority.

    The cost of the treatment shall be the responsibility of the license holder, but the responsibility does not preclude payment by an employer, existing insurance coverage, or other sources.  Primary alcoholism or drug treatment shall be provided by approved treatment facilities under RCW 70.96A.020(((2))):  PROVIDED, That nothing shall prohibit the disciplining authority from approving additional services and programs as an adjunct to primary alcoholism or drug treatment.  The disciplining authority may also approve the use of out-of-state programs.  Referral of the license holder to the program shall be done only with the consent of the license holder.  Referral to the program may also include probationary conditions for a designated period of time.  If the license holder does not consent to be referred to the program or does not successfully complete the program, the disciplining authority may take appropriate action under RCW 18.130.160.  The secretary shall adopt uniform rules for the evaluation by the disciplinary authority of a relapse or program violation on the part of a license holder in the substance abuse monitoring program.  The evaluation shall encourage program participation with additional conditions, in lieu of disciplinary action, when the disciplinary authority determines that the license holder is able to continue with reasonable skill and safety.

    (2) In addition to approving substance abuse monitoring programs that may receive referrals from the disciplining authority, the disciplining authority may establish by rule requirements for participation of license holders who are not being investigated or monitored by the disciplining authority for substance abuse.  License holders voluntarily participating in the approved programs without being referred by the disciplining authority shall not be subject to disciplinary action under RCW 18.130.160 for their substance abuse, and shall not have their participation made known to the disciplining authority, if they meet the requirements of this section and the program in which they are participating.

    (3) The license holder shall sign a waiver allowing the program to release information to the disciplining authority if the licensee does not comply with the requirements of this section or is unable to practice with reasonable skill or safety.  The substance abuse program shall report to the disciplining authority any license holder who fails to comply with the requirements of this section or the program or who, in the opinion of the program, is unable to practice with reasonable skill or safety.  License holders shall report to the disciplining authority if they fail to comply with this section or do not complete the program's requirements.  License holders may, upon the agreement of the program and disciplining authority, reenter the program if they have previously failed to comply with this section.

    (4) The treatment and pretreatment records of license holders referred to or voluntarily participating in approved programs shall be confidential, shall be exempt from RCW 42.17.250 through 42.17.450, and shall not be subject to discovery by subpoena or admissible as evidence except for monitoring records reported to the disciplining authority

for cause as defined in subsection (3) of this section. Monitoring records relating to license holders referred to the program by the disciplining authority or relating to license holders reported to the disciplining authority by the program for cause, shall be released to the disciplining authority at the request of the disciplining authority. Records held by the disciplining authority under this section shall be exempt from RCW 42.17.250 through 42.17.450 and shall not be subject to discovery by subpoena except by the license holder.

    (5) "Substance abuse," as used in this section, means the impairment, as determined by the disciplining authority, of a license holder's professional services by an addiction to, a dependency on, or the use of alcohol, legend drugs, or controlled substances.

    (6) This section does not affect an employer's right or ability to make employment-related decisions regarding a license holder.  This section does not restrict the authority of the disciplining authority to take disciplinary action for any other unprofessional conduct.

    (7) A person who, in good faith, reports information or takes action in connection with this section is immune from civil liability for reporting information or taking the action.

    (a) The immunity from civil liability provided by this section shall be liberally construed to accomplish the purposes of this section and the persons entitled to immunity shall include:

    (i) An approved monitoring treatment program;

    (ii) The professional association operating the program;

    (iii) Members, employees, or agents of the program or association;

    (iv) Persons reporting a license holder as being impaired or providing information about the license holder's impairment; and

    (v) Professionals supervising or monitoring the course of the impaired license holder's treatment or rehabilitation.

    (b) The immunity provided in this section is in addition to any other immunity provided by law.

    (((8) In addition to health care professionals governed by this chapter, this section also applies to pharmacists under chapter 18.64 RCW and pharmacy assistants under chapter 18.64A RCW.  For that purpose, the board of pharmacy shall be deemed to be the disciplining authority and the substance abuse monitoring program shall be in lieu of disciplinary action under RCW 18.64.160 or 18.64A.050.  The board of pharmacy shall adjust license fees to offset the costs of this program.))

    Sec. 10.  RCW 18.130.180 and 1991 c 332 s 34 and 1991 c 215 c 3 are each reenacted and amended to read as follows:

    The following conduct, acts, or conditions constitute unprofessional conduct for any license holder or applicant under the jurisdiction of this chapter:

    (1) The commission of any act involving moral turpitude, dishonesty, or corruption relating to the practice of the person's profession, whether the act constitutes a crime or not.  If the act constitutes a crime, conviction in a criminal proceeding is not a condition precedent to disciplinary action.  Upon such a conviction, however, the judgment and sentence is conclusive evidence at the ensuing disciplinary hearing of the guilt of the license holder or applicant of the crime described in the indictment or information, and of the person's violation of the statute on which it is based.  For the purposes of this section, conviction includes all instances in which a plea of guilty or nolo contendere is the basis for the conviction and all proceedings in which the sentence has been deferred or suspended.  Nothing in this section abrogates rights guaranteed under chapter 9.96A RCW;

    (2) Misrepresentation or concealment of a material fact in obtaining a license or in reinstatement thereof;

    (3) All advertising which is false, fraudulent, or misleading;

    (4) Incompetence, negligence, or malpractice which results in injury to a patient or which creates an unreasonable risk that a patient may be harmed.  The use of a nontraditional treatment by itself shall not constitute unprofessional conduct, provided that it does not result in injury to a patient or create an unreasonable risk that a patient may be harmed;

    (5) Suspension, revocation, or restriction of the individual's license to practice the profession by competent authority in any state, federal, or foreign jurisdiction, a certified copy of the order, stipulation, or agreement being conclusive evidence of the revocation, suspension, or restriction;

    (6) The possession, use, prescription for use, or distribution of controlled substances or legend drugs in any way other than for legitimate or therapeutic purposes, diversion of controlled substances or legend drugs, the violation of any drug law, or prescribing controlled substances for oneself;

    (7) Violation of any state or federal statute or administrative rule regulating the profession in question, including any statute or rule defining or establishing standards of patient care or professional conduct or practice;

    (8) Failure to cooperate with the disciplining authority by:

    (a) Not furnishing any papers or documents;

    (b) Not furnishing in writing a full and complete explanation covering the matter contained in the complaint filed with the disciplining authority; or

    (c) Not responding to subpoenas issued by the disciplining authority, whether or not the recipient of the subpoena is the accused in the proceeding;

    (9) Failure to comply with an order issued by the ((disciplining)) disciplinary authority or ((an assurance of discontinuance)) a stipulation for informal disposition entered into with the ((disciplining)) disciplinary authority;

    (10) Aiding or abetting an unlicensed person to practice when a license is required;

    (11) Violations of rules established by any health agency;

    (12) Practice beyond the scope of practice as defined by law or rule;

    (13) Misrepresentation or fraud in any aspect of the conduct of the business or profession;

    (14) Failure to adequately supervise auxiliary staff to the extent that the consumer's health or safety is at risk;

    (15) Engaging in a profession involving contact with the public while suffering from a contagious or infectious disease involving serious risk to public health;

    (16) Promotion for personal gain of any unnecessary or inefficacious drug, device, treatment, procedure, or service;

    (17) Conviction of any gross misdemeanor or felony relating to the practice of the person's profession.  For the purposes of this subsection, conviction includes all instances in which a plea of guilty or nolo contendere is the basis for conviction and all proceedings in which the sentence has been deferred or suspended.  Nothing in this section abrogates rights guaranteed under chapter 9.96A RCW;

    (18) The procuring, or aiding or abetting in procuring, a criminal abortion;

    (19) The offering, undertaking, or agreeing to cure or treat disease by a secret method, procedure, treatment, or medicine, or the treating, operating, or prescribing for any health condition by a method, means, or procedure which the licensee refuses to divulge upon demand of the disciplining authority;

    (20) The willful betrayal of a practitioner-patient privilege as recognized by law;

    (21) Violation of chapter 19.68 RCW;

    (22) Interference with an investigation or disciplinary proceeding by willful misrepresentation of facts before the disciplining authority or its authorized representative, or by the use of threats or harassment against any patient or witness to prevent them from providing evidence in a disciplinary proceeding or any other legal action;

    (23) Current misuse of:

    (a) Alcohol;

    (b) Controlled substances; or

    (c) Legend drugs;

    (24) Abuse of a client or patient or sexual contact with a client or patient;

    (25) Acceptance of more than a nominal gratuity, hospitality, or subsidy offered by a representative or vendor of medical or health-related products or services intended for patients, in contemplation of a sale or for use in research publishable in professional journals, where a conflict of interest is presented, as defined by rules of the disciplining authority, in consultation with the department, based on recognized professional ethical standards.

NEW SECTION. Sec. 11.  A new section is added to chapter 18.130 RCW to read as follows:

    (1) The secretary shall develop uniform procedural rules to respond to public inquiries concerning complaints and their disposition, active investigations, statement of charges, findings of fact, and final orders involving a licensee, applicant, or unlicensed person.  The uniform procedural rules adopted under this subsection apply to all adjudicative proceedings conducted under this chapter and shall include provisions for the establishing time lines for discovery, settlement, and scheduling hearings.

    (2) The uniform procedures for conducting investigations shall provide that prior to taking a written statement:

    (a) For violation of this chapter, the investigator shall inform such person, in writing of:  (i) The nature of the complaint; (ii) that the person may consult with legal counsel at his or her expense prior to making a statement; and (iii) that any statement that the person makes may be used in  an adjudicative proceeding conducted under this chapter; and

    (b) From a witness or potential witness in an investigation under this chapter, the investigator shall inform the person, in writing, that the statement may be released to the licensee, applicant, or unlicensed person under investigation if a statement of charges is issued.

    (3) The disciplining authority may enter into an agreement to dispose of a matter with or without a finding of unprofessional conduct or inability to practice, which may include one or more sanctions set forth in RCW 18.130.160.  If the representative of the disciplining authority and the respondent have entered into a written settlement agreement, such agreement shall be submitted to the disciplining authority for approval.  In considering whether to approve the settlement, the disciplining authority may consider such written materials as the parties may agree.  If no settlement is approved by the disciplining authority and the matter proceeds to a hearing, a person who participated in the decision not to approve the proposed settlement may not participate as a hearing officer or board panel member in the hearing.

    (4) In order to assure the uniform application of the procedural rules developed by the secretary, the secretary or his or her designee shall serve as presiding officer for all proceedings under this chapter, including those conducted by disciplinary authorities identified in RCW 18.130.040(2)(b), other than the board of funeral directors and embalmers, and shall perform all functions of the presiding officer under chapter 34.05 RCW.  In those areas where the disciplining authority is a board, the secretary or his or her designee, shall not vote on the final decision.

    Sec. 12.  RCW 18.130.185 and 1987 c 150 s 8 are each amended to read as follows:

    If a person or business regulated by this chapter violates RCW 18.130.170 or 18.130.180, the attorney general, any prosecuting attorney, the ((director)) secretary, the board, or any other person may maintain an action in the name of the state of Washington to enjoin the person from committing the violations.  The injunction shall not relieve the offender from criminal prosecution, but the remedy by injunction shall be in addition to the liability of the offender to criminal prosecution and disciplinary action.

    Sec. 13.  RCW 18.130.186 and 1989 c 125 s 3 are each amended to read as follows:

    (1) To implement a substance abuse monitoring program for license holders specified under RCW 18.130.040, who are impaired by substance abuse, the disciplinary authority may enter into a contract with a voluntary substance abuse program under RCW 18.130.175.  The program may include any or all of the following:

    (a) Contracting with providers of treatment programs;

    (b) Receiving and evaluating reports of suspected impairment from any source;

    (c) Intervening in cases of verified impairment;

    (d) Referring impaired license holders to treatment programs;

    (e) Monitoring the treatment and rehabilitation of impaired license holders including those ordered by the disciplinary authority;

    (f) Providing education, prevention of impairment, posttreatment monitoring, and support of rehabilitated impaired license holders; and

    (g) Performing other activities as agreed upon by the disciplinary authority.

    (2) A contract entered into under subsection (1) of this section may be financed by a surcharge on each license issuance or renewal to be collected by the department of ((licensing)) health from the license holders of the same regulated health profession.  These moneys shall be placed in the health professions account to be used solely for the implementation of the program.

    Sec. 14.  RCW 18.130.190 and 1991 c 3 s 271 are each amended to read as follows:

    (1) The secretary shall investigate complaints concerning practice by unlicensed persons of a profession or business for which a license is required by the chapters specified in RCW 18.130.040.  In the investigation of the complaints, the secretary shall have the same authority as provided the secretary under RCW 18.130.050.  ((The secretary shall issue a cease and desist order to a person after notice and hearing and upon a determination that the person has violated this subsection.))

(2) The secretary may issue a notice of intention to issue a cease and desist order to any person whom the secretary has reason to believe is engaged in the unlicensed practice of a profession or business for which a license is required by the chapters specified in RCW 18.130.040.  The person to whom such notice is issued may request an adjudicative proceeding to contest the charges.  The request for hearing must be filed within twenty days after service of the notice of intention to issue a cease and desist order.  The failure to request a hearing constitutes a default, whereupon the secretary may enter a permanent cease and desist order, which may include a civil fine.  All proceedings shall be conducted in accordance with chapter 34.05 RCW.

(3) If the secretary makes a final determination that a person has engaged or is engaging in unlicensed practice, the secretary may issue a cease and desist order.  In addition, the secretary may impose a civil fine in an amount not exceeding one thousand dollars for each day upon which the person engaged in unlicensed practice of a business or profession for which a license is required by one or more of the chapters specified in RCW 18.130.040.  The proceeds of such fines shall be deposited to the health professions account.

(4) If the secretary makes a written finding of fact that the public interest will be irreparably harmed by delay in issuing an order, the secretary may issue a temporary cease and desist order.  The person receiving a temporary cease and desist order shall be provided an opportunity for a prompt hearing.  The temporary cease and desist order shall remain in effect until further order of the secretary.  The failure to request a prompt or regularly scheduled hearing constitutes a default, whereupon the secretary may enter a permanent cease and desist order, which may include a civil fine.

(5) Neither the issuance of a cease and desist order nor payment of a civil fine shall ((not)) relieve the person so practicing or operating a business without a license from criminal prosecution therefor, but the remedy of a cease and desist order or civil fine shall be in addition to any criminal liability.  The cease and desist order is conclusive proof of unlicensed practice and may be enforced under RCW 7.21.060.  This method of enforcement of the cease and desist order or civil fine may be used in addition to, or as an alternative to, any provisions for enforcement of agency orders set out in chapter 34.05 RCW.

    (((2))) (6) The attorney general, a county prosecuting attorney, the secretary, a board, or any person may in accordance with the laws of this state governing injunctions, maintain an action in the name of this state to enjoin any person practicing a profession or business for which a license is required by the chapters specified in RCW 18.130.040 without a license from engaging in such practice or operating such business until the required license is secured.  However, the injunction shall not relieve the person so practicing or operating a business without a license from criminal prosecution therefor, but the remedy by injunction shall be in addition to any criminal liability.

    (((3))) (7) Unlicensed practice of a profession or operating a business for which a license is required by the chapters specified in RCW 18.130.040, unless otherwise exempted by law, constitutes a gross misdemeanor.  All fees, fines, forfeitures, and penalties collected or assessed by a court because of a violation of this section shall be remitted to the health professions account.

    Sec. 15.  RCW 18.130.300 and 1984 c 279 s 21 are each amended to read as follows:

    The ((director)) secretary, members of the boards, or individuals acting on their behalf are immune from suit in any action, civil or criminal, based on any disciplinary proceedings or other official acts performed in the course of their duties.

    Sec. 16.  RCW 18.25.005 and 1992 c 241 s 2 are each amended to read as follows:

    (1) Chiropractic is the practice of health care that deals with the diagnosis or analysis and care or treatment of the vertebral subluxation complex and its effects, articular dysfunction, and musculoskeletal disorders, all for the restoration and maintenance of health and recognizing the recuperative powers of the body.

    (2) Chiropractic treatment or care includes the use of procedures involving spinal adjustments, and extremity manipulation insofar as any such procedure is complementary or preparatory to a chiropractic spinal adjustment.  Chiropractic treatment also includes the use of heat, cold, water, exercise, massage, trigger point therapy, dietary advice and recommendation of nutritional supplementation except for medicines of herbal, animal, or botanical origin, the normal regimen and rehabilitation of the patient, first aid, and counseling on hygiene, sanitation, and preventive measures.  Chiropractic care also includes such physiological therapeutic procedures as traction and light, but does not include procedures involving the application of sound, diathermy, or electricity.

    (3) As part of a chiropractic differential diagnosis, a chiropractor shall perform a physical examination, which may include diagnostic x-rays, to determine the appropriateness of chiropractic care or the need for referral to other health care providers.  The ((chiropractic disciplinary)) board shall provide by rule for the type and use of diagnostic and analytical devices and procedures consistent with this chapter.

    (4) Chiropractic care shall not include the prescription or dispensing of any medicine or drug, the practice of obstetrics or surgery, the use of x-rays or any other form of radiation for therapeutic purposes, colonic irrigation, or any form of venipuncture.

    (5) Nothing in this chapter prohibits or restricts any other practitioner of a "health profession" defined in RCW 18.120.020(4) from performing any functions or procedures the practitioner is licensed or permitted to perform, and the term "chiropractic" as defined in this chapter shall not prohibit a practitioner licensed under chapter 18.71 RCW from performing medical procedures, except such procedures shall not include the adjustment by hand of any articulation of the spine.

    Sec. 17.  RCW 18.25.006 and 1992 c 241 s 3 are each amended to read as follows:

    Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.

    (1) "Department" means the department of health.

    (2) "Secretary" means the secretary of the department of health or the secretary's designee.

    (3) "Chiropractor" means an individual licensed under this chapter.

    (4) "Board" means the Washington state board of chiropractic ((examiners)).

    (5) "Vertebral subluxation complex" means a functional defect or alteration of the biomechanical and physiological dynamics in a joint that may cause neuronal disturbances, with or without displacement detectable by x-ray.  The effects of the vertebral subluxation complex may include, but are not limited to, any of the following:  Fixation, hypomobility, hypermobility, periarticular muscle spasm, edema, or inflammation.

    (6) "Articular dysfunction" means an alteration of the biomechanical and physiological dynamics of a joint of the axial or appendicular skeleton.

    (7) "Musculoskeletal disorders" means abnormalities of the muscles, bones, and connective tissue.

    (8) "Chiropractic differential diagnosis" means a diagnosis to determine the existence of a vertebral subluxation complex, articular dysfunction, or musculoskeletal disorder, and the appropriateness of chiropractic care or the need for referral to other health care providers.

    (9) "Chiropractic adjustment" means chiropractic care of a vertebral subluxation complex, articular dysfunction, or musculoskeletal disorder.  Such care includes manual or mechanical adjustment of any vertebral articulation and contiguous articulations beyond the normal passive physiological range of motion.

    (10) "Extremity manipulation" means a corrective thrust or maneuver applied to a joint of the appendicular skeleton.  The use of extremity manipulation shall be complementary and preparatory to a chiropractic spinal adjustment to support correction of a vertebral subluxation complex and is considered a part of a spinal adjustment and shall not be billed separately from or in addition to a spinal adjustment.

    Sec. 18.  RCW 18.25.019 and 1987 c 150 s 12 are each amended to read as follows:

    The uniform disciplinary act, chapter 18.130 RCW, governs unlicensed practice and the issuance and denial of licenses and the disciplining of licensees under this chapter.

    Sec. 19.  RCW 18.25.020 and 1991 c 3 s 38 are each amended to read as follows:

    (1) Any person not now licensed to practice chiropractic in this state and who desires to practice chiropractic in this state, before it shall be lawful for him or her to do so, shall make application therefor to the secretary, upon such form and in such manner as may be adopted and directed by the secretary.  Each applicant who matriculates to a chiropractic college after January 1, 1975, shall have completed not less than one-half of the requirements for a baccalaureate degree at an accredited and approved college or university and shall be a graduate of a chiropractic school or college accredited and approved by the board ((of chiropractic examiners)) and shall show satisfactory evidence of completion by each applicant of a resident course of study of not less than four thousand classroom hours of instruction in such school or college.  Applications shall be in writing and shall be signed by the applicant in his or her own handwriting and shall be sworn to before some officer authorized to administer oaths, and shall recite the history of the applicant as to his or her educational advantages, his or her experience in matters pertaining to a knowledge of the care of the sick, how long he or she has studied chiropractic, under what teachers, what collateral branches, if any, he or she has studied, the length of time he or she has engaged in clinical practice; accompanying the same by reference therein, with any proof thereof in the shape of diplomas, certificates, and shall accompany said application with satisfactory evidence of good character and reputation.

    (2) There shall be paid to the secretary by each applicant for a license, a fee determined by the secretary as provided in RCW 43.70.250 which shall accompany application and a fee determined by the secretary as provided in RCW 43.70.250, which shall be paid upon issuance of license.  Like fees shall be paid for any subsequent examination and application.

    Sec. 20.  RCW 18.25.030 and 1989 c 258 s 4 are each amended to read as follows:

    Examinations for license to practice chiropractic shall be made by the board ((of chiropractic examiners)) according to the method deemed by it to be the most practicable and expeditious to test the applicant's qualifications.  Such application shall be designated by a number instead of his or her name, so that the identity shall not be discovered or disclosed to the members of the examining committee until after the examination papers are graded.

    All examinations shall be in whole or in part in writing, the subject of which shall be as follows:  Anatomy, physiology, spinal anatomy, microbiology-public health, general diagnosis, neuromuscularskeletal diagnosis, x-ray, principles of chiropractic and adjusting, as taught by chiropractic schools and colleges.  The board shall administer a practical examination to applicants which shall consist of diagnosis, principles and practice, x-ray, and adjustive technique consistent with chapter 18.25 RCW.  A license shall be granted to all applicants whose score over each subject tested is seventy-five percent.  The board may enact additional requirements for testing administered by the national board of chiropractic examiners.

    Sec. 21.  RCW 18.25.040 and 1991 c 320 s 8 are each amended to read as follows:

    Persons licensed to practice chiropractic under the laws of any other state, territory of the United States, the District of Columbia, Puerto Rico, or province of Canada, having qualifications substantially equivalent to those required by this chapter, may, in the discretion of the board ((of chiropractic examiners)), and after such examination as may be required by rule of the board, be issued a license to practice in this state without further examination, upon payment of a fee determined by the secretary as provided in RCW 43.70.250.

    Sec. 22.  RCW 18.25.070 and 1991 c 3 s 40 are each amended to read as follows:

    (1) Every person practicing chiropractic shall, as a prerequisite to annual renewal of license, submit to the secretary at the time of application therefor, satisfactory proof showing attendance of at least twenty-five hours during the preceding twelve-month period, at one or more chiropractic symposiums which are recognized and approved by the board ((of chiropractic examiners:  PROVIDED, That)).  The board may, for good cause shown, waive said attendance.  The following guidelines for such symposiums shall apply:

    (a) The board shall set criteria for the course content of educational symposia concerning matters which are recognized by the state of Washington chiropractic licensing laws; it shall be the licensee's responsibility to determine whether the course content meets these criteria;

    (b) The board shall adopt standards for distribution of annual continuing education credit requirements;

    (c) Rules shall be adopted by the board for licensees practicing and residing outside the state who shall meet all requirements established by the board by rules ((and regulations)).

    (2) Every person practicing chiropractic within this state shall pay on or before his or her birth anniversary date, after a license is issued to him or her as herein provided, to said secretary a renewal license fee to be determined by the secretary as provided in RCW 43.70.250.  The secretary shall, thirty days or more before the birth anniversary date of each chiropractor in the state, mail to that chiropractor a notice of the fact that the renewal fee will be due on or before his or her birth anniversary date.  Nothing in this chapter shall be construed so as to require that the receipts shall be recorded as original licenses are required to be recorded.

    The failure of any licensed chiropractor to pay his or her annual license renewal fee within thirty days of license expiration shall work a forfeiture of his or her license.  It shall not be reinstated except upon evidence that continuing educational requirements have been fulfilled and the payment of a penalty to be determined by the secretary as provided in RCW 43.70.250, together with all annual license renewal fees delinquent at the time of the forfeiture, and those for each year thereafter up to the time of reinstatement.  Should the licentiate allow his or her license to elapse for more than three years, he or she may be reexamined as provided for in RCW 18.25.040 at the discretion of the board.

    Sec. 23.  RCW 18.25.190 and 1991 c 320 s 10 are each amended to read as follows:

    Nothing in this chapter shall be construed to prohibit:

    (1) The temporary practice in this state of chiropractic by any chiropractor licensed by another state, territory, or country in which he or she resides.  However, the chiropractor shall not establish a practice open to the general public and shall not engage in temporary practice under this section for a period longer than thirty days.  The chiropractor shall register his or her intention to engage in the temporary practice of chiropractic in this state with the board of chiropractic examiners before engaging in the practice of chiropractic, and shall agree to be bound by such conditions as may be prescribed by rule by the board.

    (2) The practice of chiropractic, except the administration of a chiropractic adjustment, by a person who is a regular senior student in an accredited school of chiropractic approved by the board if the practice is part of a regular course of instruction offered by the school and the student is under the direct supervision and control of a chiropractor duly licensed pursuant to this chapter and approved by the board.

    (3) The practice of chiropractic by a person serving a period of postgraduate chiropractic training in a program of clinical chiropractic training sponsored by a school of chiropractic accredited in this state if the practice is part of his or her duties as a clinical postgraduate trainee and the trainee is under the direct supervision and control of a chiropractor duly licensed pursuant to this chapter and approved by the board.

    (4) The practice of chiropractic by a person who is eligible and has applied to take the next available examination for licensing offered by the board ((of chiropractic examiners)), except that the unlicensed chiropractor must provide all services under the direct control and supervision of a licensed chiropractor approved by the board.  The unlicensed chiropractor may continue to practice as provided by this subsection until the results of the next available examination are published, but in no case for a period longer than six months.  The board shall adopt rules necessary to effectuate the intent of this subsection.

    Any provision of chiropractic services by any individual under subsection (1), (2), (3), or (4) of this section shall be subject to the jurisdiction of the chiropractic disciplinary board as provided in chapters 18.26 and 18.130 RCW.

    Sec. 24.  RCW 18.26.030 and 1986 c 259 s 25 are each amended to read as follows:

    (1) In addition to those acts defined in chapter 18.130 RCW, the term "unprofessional conduct" as used in this chapter ((and chapter 18.25 RCW)) includes failing to differentiate chiropractic care from any and all other methods of healing at all times.

    (2) Proceedings involving alleged unprofessional conduct shall be conducted by the attorney general upon the direction of the board.

    Sec. 25.  RCW 18.26.040 and 1989 c 258 s 9 are each amended to read as follows:

    There is hereby created the Washington state board of chiropractic ((disciplinary board of seven)) of ten members to be composed of ((six)) seven chiropractic members to be appointed by the governor, and ((one)) three members appointed by the governor who shall be representative of the public at large.  For at least five years preceding the time of their appointment, and during their tenure of office, the chiropractic members of the board must be residents of Washington.

    In addition, the doctors of chiropractic shall have been engaged in the active licensed practice of chiropractic in this state for a minimum of five years.

    Board appointments shall be for a term of five years.  No board member shall serve more than two consecutive full terms.

    Sec. 26.  RCW 18.26.390 and 1991 c 320 s 11 are each amended to read as follows:

    The board may adopt rules necessary and appropriate to implement RCW 18.26.320 through 18.26.380 (as recodified by this act).

    Sec. 27.  RCW 18.32.010 and 1991 c 3 s 58 are each amended to read as follows:

    Words used in the singular in this chapter may also be applied to the plural of the persons and things; words importing the plural may be applied to the singular; words importing the masculine gender may be extended to females also; the term "board" used in this chapter shall mean the Washington state board of ((dental examiners)) dentistry and the term "secretary" shall mean the secretary of health of the state of Washington.

    Sec. 28.  RCW 18.32.030 and 1991 c 3 s 59 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 Washington state dental schools or colleges approved by the board, 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 board ((of dental examiners));

    (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 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 persons not licensed under this chapter when performed under the supervision of a licensed dentist:  PROVIDED HOWEVER, That such nonlicensed person 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, and 18.88 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. 29.  RCW 18.32.195 and 1992 c 59 s 1 are each amended to read as follows:

    The board may, without examination, issue a license to persons who possess the qualifications set forth in this section.

    (1) The board may, upon written request of the dean of the school of dentistry of the University of Washington, issue a license to practice dentistry in this state to persons who have been licensed or otherwise authorized to practice dentistry in another state or country and who have been accepted for employment by the school of dentistry as full-time faculty members.  For purposes of this subsection, this means teaching members of the faculty of the school of dentistry of the University of Washington who are so employed on a one hundred percent of work time basis.  Such license shall permit the holder thereof to practice dentistry within the confines of the university facilities for a period of one year while he or she is so employed as a full-time faculty member by the school of dentistry of the University of Washington.  It shall terminate whenever the holder ceases to be such a full-time faculty member.  Such license shall permit the holder thereof to practice dentistry only in connection with his or her duties in employment with the school of dentistry of the University of Washington.  This limitation shall be stated on the license.

    (2) The board may, upon written request of the dean of the school of dentistry of the University of Washington, issue a limited license to practice dentistry in this state to university residents in postgraduate dental education.  The license shall permit the resident dentist to provide dental care only in connection with his or her duties as a university resident.

    (3) The board may condition the granting of a license under this section with terms the board deems appropriate.  All persons licensed under this section shall be subject to the jurisdiction of the ((dental disciplinary)) board to the same extent as other members of the dental profession, in accordance with this chapter, and in addition the licensee may be disciplined by the ((dental disciplinary)) board after a hearing has been held in accordance with the provisions set forth in this chapter, and determination by the ((dental disciplinary)) board that such licensee has violated any of the restrictions set forth in this section.

    (4) Persons applying for licensure pursuant to this section shall pay the application fee determined by the secretary and, in the event the license applied for is issued, a license fee at the rate provided for licenses generally.  After review by the board ((of dental examiners)), licenses issued under this section may be renewed annually if the licensee continues to be employed as a full-time faculty member of the school of dentistry of the University of Washington, or a university resident in postgraduate dental education, and otherwise meets the requirements of the provisions and conditions deemed appropriate by the board of dental examiners.  Any person who obtains a license pursuant to this section may, without an additional application fee, apply for licensure under this chapter, in which case the applicant shall be subject to examination and the other requirements of this chapter.

    Sec. 30.  RCW 18.32.560 and 1984 c 279 s 51 are each amended to read as follows:

    There is hereby created the Washington state ((dental disciplinary)) board of dentistry, which shall be composed of ((five)) twelve members, each of whom shall be a resident of this state engaged in the active practice of dentistry and who shall have been licensed to practice dentistry in this state for a period of five years or more prior to appointment to the board.  Of the ((five)) twelve members appointed to the board, ((two)) five members shall reside and engage in the active practice of dentistry east of the summit of the Cascade range and the other three members shall reside and engage in the active practice of dentistry west of the summit of the Cascade range.

    The attorney general shall be counsel to the board and shall represent it in all legal proceedings.

    In addition to the members specified in this section, the governor shall appoint ((a consumer member of the board.  The consumer member shall serve a term of six years commencing on October 1st)) four consumers to the board.  The consumer members shall serve six-year terms commencing on October 1st.  The governor may stagger the initial terms of the consumer members.

    Sec. 31.  RCW 18.32.655 and 1986 c 259 s 35 are each amended to read as follows:

    The ((dental disciplinary)) board has the power and it shall be its duty to((:  (1))) require licensed dentists to keep and maintain a copy of each laboratory referral instruction, describing detailed services rendered, for a period to be determined by the board but not more than three years, and to require the production of all such records for examination by the board or its authorized representatives; and (((2) Promulgate)) adopt reasonable rules ((and regulations)) requiring licensed dentists to make, maintain and produce for examination by the board or its authorized representatives such other records as may be reasonable and proper in the performance of its duties and enforcing the provisions of this chapter.

    Sec. 32.  RCW 18.50.115 and 1991 c 3 s 112 are each amended to read as follows:

    A midwife licensed under this chapter may obtain and administer prophylactic ophthalmic medication, postpartum oxytocic, vitamin K, Rho immune globulin (human), and local anesthetic and may administer such other drugs or medications as prescribed by a physician.  A pharmacist who dispenses such drugs to a licensed midwife shall not be liable for any adverse reactions caused by any method of use by the midwife.

    The secretary, after consultation with representatives of the midwife advisory committee, the board of pharmacy, and the board of ((medical examiners)) medicine, may issue regulations which authorize licensed midwives to purchase and use legend drugs and devices in addition to the drugs authorized in this chapter.

    Sec. 33.  RCW 18.64.160 and 1985 c 7 s 60 are each amended to read as follows:

In addition to the grounds under RCW 18.130.170 and 18.130.180, the board of pharmacy ((shall have the power to refuse, suspend, or revoke)) may take disciplinary action against the license of any pharmacist or intern upon proof that:

    (1) His or her license was procured through fraud, misrepresentation, or deceit;

    (2) ((He or she has been convicted of a felony relating to his or her practice as a pharmacist;

    (3) He or she has committed any act involving moral turpitude, dishonesty, or corruption, if the act committed directly relates to the pharmacist's fitness to practice pharmacy.  Upon such conviction, however, the judgment and sentence shall be conclusive evidence at the ensuing disciplinary hearing of the guilt of the respondent pharmacist of the crime described in the indictment or information, and of his or her violation of the statute upon which it is based;

    (4) He or she is unfit to practice pharmacy because of habitual intemperance in the use of alcoholic beverages, drugs, controlled substances, or any other substance which impairs the performance of professional duties;

    (5) He or she exhibits behavior which may be due to physical or mental impairment, which creates an undue risk of causing harm to him or herself or to other persons when acting as a licensed pharmacist or intern;

    (6) He or she has incompetently or negligently practiced pharmacy, creating an unreasonable risk of harm to any individual;

    (7) His or her legal authority to practice pharmacy, issued by any other properly constituted licensing authority of any other state, has been and is currently suspended or revoked;

    (8))) In the event that a pharmacist is determined by a court of competent jurisdiction to be mentally incompetent, the pharmacist shall automatically have his or her license suspended by the board upon the entry of the judgment, regardless of the pendency of an appeal;

    (((9))) (3) He or she has knowingly violated or permitted the violation of any provision of any state or federal law, rule, or regulation governing the possession, use, distribution, or dispensing of drugs, including, but not limited to, the violation of any provision of this chapter, Title 69 RCW, or rule or regulation of the board;

    (((10))) (4) He or she has knowingly allowed any unlicensed person to take charge of a pharmacy or engage in the practice of pharmacy, except a pharmacy intern or pharmacy assistant acting as authorized in this chapter or chapter 18.64A RCW in the presence of and under the immediate supervision of a licensed pharmacist;

    (((11))) (5) He or she has compounded, dispensed, or caused the compounding or dispensing of any drug or device which contains more or less than the equivalent quantity of ingredient or ingredients specified by the person who prescribed such drug or device((:  PROVIDED, HOWEVER, That)).  Nothing herein shall be construed to prevent the pharmacist from exercising professional judgment in the preparation or providing of such drugs or devices.

    ((In any case of the refusal, suspension, or revocation of a license by said board of pharmacy under the provisions of this chapter, said board shall proceed in accordance with chapter 34.05 RCW.))

NEW SECTION. Sec. 34.  A new section is added to chapter 18.64 RCW to read as follows:

    The uniform disciplinary act, chapter 18.130 RCW, governs unlicensed practice, the issuance and denial of licenses of pharmacists and pharmacy interns, and the discipline of licensed pharmacists and pharmacy interns under this chapter.

    Sec. 35.  RCW 18.64A.050 and 1989 1st ex.s. c 9 s 424 are each amended to read as follows:

In addition to the grounds under RCW 18.130.170 and 18.130.180, the board of pharmacy ((shall have the power to refuse, suspend, or revoke)) may take disciplinary action against the certificate of any pharmacy assistant upon proof that:

    (1) His or her certificate was procured through fraud, misrepresentation or deceit;

    (2) He or she has been found guilty of any offense in violation of the laws of this state relating to drugs, poisons, cosmetics or drug sundries by any court of competent jurisdiction.  Nothing herein shall be construed to affect or alter the provisions of RCW 9.96A.020;

    (3) ((He or she is unfit to perform his or her duties because of habitual intoxication or abuse of controlled substances;

    (4))) He or she has exhibited gross incompetency in the performance of his or her duties;

    (((5))) (4) He or she has willfully or repeatedly violated any of the rules and regulations of the board of pharmacy or of the department;

    (((6))) (5) He or she has willfully or repeatedly performed duties beyond the scope of his or her certificate in violation of the provisions of this chapter; or

    (((7))) (6) He or she has impersonated a licensed pharmacist.

    ((In any case of the refusal, suspension or revocation of a certificate by the board, a hearing shall be conducted in accordance with RCW 18.64.160, as now or hereafter amended, and appeal may be taken in accordance with the Administrative Procedure Act, chapter 34.05 RCW.))

NEW SECTION. Sec. 36.  A new section is added to chapter 18.64A RCW to read as follows:

    The uniform disciplinary act, chapter 18.130 RCW, governs the issuance and denial of certificates, and the discipline of certificants under this chapter.

    Sec. 37.  RCW 18.71.010 and 1991 c 3 s 158 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) "Board" means the board of ((medical examiners)) medicine.

    (2) "Secretary" means the secretary of health.

    (3) "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) "Emergency medical care" or "emergency medical service" has the same meaning as in chapter 18.73 RCW.

    Sec. 38.  RCW 18.71.019 and 1987 c 150 s 45 are each amended to read as follows:

    The uniform disciplinary act, chapter 18.130 RCW, governs unlicensed practice and the issuance ((and)), denial of licenses, and the discipline of licensees under this chapter.

    Sec. 39.  RCW 18.71.030 and 1990 c 196 s 12 and 1990 c 33 s 552 are each reenacted and amended to read as follows:

    Nothing in this chapter shall be construed to apply to or interfere in any way with the practice of religion or any kind of treatment by prayer; nor shall anything in this chapter be construed to prohibit:

    (1) The furnishing of medical assistance in cases of emergency requiring immediate attention;

    (2) The domestic administration of family remedies;

    (3) The administration of oral medication of any nature to students by public school district employees or private elementary or secondary school employees as provided for in chapter 28A.210 RCW;

    (4) The practice of dentistry, osteopathy, osteopathy and surgery, nursing, chiropractic, ((podiatry)) podiatric medicine and surgery, optometry, naturopathy or any other healing art licensed under the methods or means permitted by such license;

    (5) The practice of medicine in this state by any commissioned medical officer serving in the armed forces of the United States or public health service or any medical officer on duty with the United States veterans administration while such medical officer is engaged in the performance of the duties prescribed for him or her by the laws and regulations of the United States;

    (6) The practice of medicine by any practitioner licensed by another state or territory in which he or she resides, provided that such practitioner shall not open an office or appoint a place of meeting patients or receiving calls within this state;

    (7) The practice of medicine by a person who is a regular student in a school of medicine approved and accredited by the board, however, the performance of such services be only pursuant to a regular course of instruction or assignments from his or her instructor, or that such services are performed only under the supervision and control of a person licensed pursuant to this chapter;

    (8) The practice of medicine by a person serving a period of postgraduate medical training in a program of clinical medical training sponsored by a college or university in this state or by a hospital accredited in this state, however, the performance of such services shall be only pursuant to his or her duties as a trainee;

    (9) The practice of medicine by a person who is regularly enrolled in a physician assistant program approved by the board, however, the performance of such services (([shall])) shall be only pursuant to a regular course of instruction in said program and such services are performed only under the supervision and control of a person licensed pursuant to this chapter;

    (10) The practice of medicine by a licensed physician assistant which practice is performed under the supervision and control of a physician licensed pursuant to this chapter;

    (11) The practice of medicine, in any part of this state which shares a common border with Canada and which is surrounded on three sides by water, by a physician licensed to practice medicine and surgery in Canada or any province or territory thereof;

    (12) The administration of nondental anesthesia by a dentist who has completed a residency in anesthesiology at a school of medicine approved by the board of medical examiners, however, a dentist allowed to administer nondental anesthesia shall do so only under authorization of the patient's attending surgeon, obstetrician, or psychiatrist and the ((medical disciplinary)) board shall have jurisdiction to discipline a dentist practicing under this exemption and enjoin or suspend such dentist from the practice of nondental anesthesia according to the provisions of chapter ((18.72 RCW and chapter)) 18.130 RCW;

    (13) Emergency lifesaving service rendered by a physician's trained mobile intravenous therapy technician, by a physician's trained mobile airway management technician, or by a physician's trained mobile intensive care paramedic, as defined in RCW 18.71.200, if the emergency lifesaving service is rendered under the responsible supervision and control of a licensed physician;

    (14) The provision of clean, intermittent bladder catheterization for students by public school district employees or private school employees as provided for in RCW 18.88.295 and 28A.210.280.

    Sec. 40.  RCW 18.71.095 and 1991 c 3 s 164 are each amended to read as follows:

    The board may, without examination, issue a limited license to persons who possess the qualifications set forth herein:

    (1) The board may, upon the written request of the secretary of the department of social and health services or the secretary of corrections, issue a limited license to practice medicine in this state to persons who have been accepted for employment by the department of social and health services or the department of corrections as physicians; who are licensed to practice medicine in another state of the United States or in the country of Canada or any province or territory thereof; and who meet all of the qualifications for licensure set forth in RCW 18.71.050.

    Such license shall permit the holder thereof to practice medicine only in connection with patients, residents, or inmates of the state institutions under the control and supervision of the secretary of the department of social and health services or the department of corrections.

    (2) The board may issue a limited license to practice medicine in this state to persons who have been accepted for employment by a county or city health department as physicians; who are licensed to practice medicine in another state of the United States or in the country of Canada or any province or territory thereof; and who meet all of the qualifications for licensure set forth in RCW 18.71.050.

    Such license shall permit the holder thereof to practice medicine only in connection with his or her duties in employment with the city or county health department.

    (3) Upon receipt of a completed application showing that the applicant meets all of the requirements for licensure set forth in RCW 18.71.050 except for completion of two years of postgraduate medical training, and that the applicant has been appointed as a resident physician in a program of postgraduate clinical training in this state approved by the board, the board may issue a limited license to a resident physician.  Such license shall permit the resident physician to practice medicine only in connection with his or her duties as a resident physician and shall not authorize the physician to engage in any other form of practice.  Each resident physician shall practice medicine only under the supervision and control of a physician licensed in this state, but such supervision and control shall not be construed to necessarily require the personal presence of the supervising physician at the place where services are rendered.

    (4)(a) Upon nomination by the dean of the school of medicine at the University of Washington or the chief executive officer of a hospital or other appropriate health care facility licensed in the state of Washington, the board may issue a limited license to a physician applicant invited to serve as a teaching-research member of the institution's instructional staff if the sponsoring institution and the applicant give evidence that he or she has graduated from a recognized medical school and has been licensed or otherwise privileged to practice medicine at his or her location of origin.  Such license shall permit the recipient to practice medicine only within the confines of the instructional program specified in the application and shall terminate whenever the holder ceases to be involved in that program, or at the end of one year, whichever is earlier.  Upon request of the applicant and the institutional authority, the license may be renewed for no more than a total of two years.

    (b) Upon nomination by the dean of the school of medicine of the University of Washington or the chief executive officer of any hospital or appropriate health care facility licensed in the state of Washington, the board may issue a limited license to an applicant selected by the sponsoring institution to be enrolled in one of its designated departmental or divisional fellowship programs provided that the applicant shall have graduated from a recognized medical school and has been granted a license or other appropriate certificate to practice medicine in the location of the applicant's origin.  Such license shall permit the holder only to practice medicine within the confines of the fellowship program to which he or she has been appointed and, upon the request of the applicant and the sponsoring institution, the license may be renewed by the board for no more than a total of two years.

    All persons licensed under this section shall be subject to the jurisdiction of the ((medical disciplinary)) board to the same extent as other members of the medical profession, in accordance with chapter((s 18.72 and)) 18.130 RCW.

    Persons applying for licensure pursuant to this section shall pay an application fee determined by the secretary as provided in RCW 43.70.250 and, in the event the license applied for is issued, a license fee at the rate provided for renewals of licenses generally.  Licenses issued hereunder may be renewed annually pursuant to the provisions of RCW 18.71.080.  Any person who obtains a limited license pursuant to this section may, without an additional application fee, apply for licensure under this chapter, but shall submit a new application form and comply with all other licensing requirements of this chapter.

    Sec. 41.  RCW 18.71.205 and 1992 c 128 s 1 are each amended to read as follows:

    (1) The secretary of the department of health, in conjunction with the advice and assistance of the emergency medical services licensing and certification advisory committee as prescribed in RCW 18.73.050, and the board ((of medical examiners)), shall prescribe:

    (a) Minimum standards and performance requirements for the certification and recertification of physician's trained intravenous therapy technicians, airway management technicians, and mobile intensive care paramedics; and

    (b) Procedures for certification, recertification, and decertification of physician's trained intravenous therapy technicians, airway management technicians, and mobile intensive care paramedics.

    (2) Initial certification shall be for a period of three years.

    (3) Recertification shall be granted upon proof of continuing satisfactory performance and education, and shall be for a period of three years.

    (4) As used in chapters 18.71 and 18.73 RCW, "approved medical program director" means a person who:

    (a) Is licensed to practice medicine and surgery pursuant to chapter 18.71 RCW or osteopathy and surgery pursuant to chapter 18.57 RCW; and

    (b) Is qualified and knowledgeable in the administration and management of emergency care and services; and

    (c) Is so certified by the department of health for a county, group of counties, or cities with populations over four hundred thousand in coordination with the recommendations of the local medical community and local emergency medical services and trauma care council.

    (5) The uniform disciplinary act, chapter 18.130 RCW, governs uncertified practice, the issuance and denial of certificates, and the disciplining of certificate holders under this section.  The secretary shall be the disciplining authority under this section.  Disciplinary action shall be initiated against a person credentialed under this chapter in a manner consistent with the responsibilities and duties of the medical program director under whom such person is responsible.

    Sec. 42.  RCW 18.71.230 and 1986 c 259 s 112 are each amended to read as follows:

    A right to practice medicine and surgery by an individual in this state pursuant to RCW 18.71.030 (5) through (12) shall be subject to discipline by order of the board upon a finding by the board of an act of unprofessional conduct as defined in RCW 18.130.180 or that the individual is unable to practice with reasonable skill or safety due to a mental or physical condition as described in RCW 18.130.170.  Such physician shall have the same rights of notice, hearing and judicial review as provided licensed physicians generally pursuant to chapter((s 18.72 and)) 18.130 RCW.

    Sec. 43.  RCW 18.71A.010 and 1990 c 196 s 1 are each amended to read as follows:

    (1) "Physician assistant" means a person who is licensed by the board to practice medicine to a limited extent only under the supervision of a physician as defined in chapter 18.71 RCW and who is academically and clinically prepared to provide health care services and perform diagnostic, therapeutic, preventative, and health maintenance services.

    (2) "Board" means the board of ((medical examiners)) medicine.

    (3) "Practice medicine" shall have the meaning defined in RCW 18.71.011.

    (4) "Secretary" means the secretary of health or the secretary's designee.

    (5) "Department" means the department of health.

    Sec. 44.  RCW 18.72.045 and 1991 c 215 s 1 are each amended to read as follows:

    There is hereby created the Washington state ((medical disciplinary)) board of medicine.  The board shall be composed of one holder of a valid license to practice medicine and surgery under this chapter from each congressional district now existing or hereafter created in the state, ((four members representing the public, and one physician assistant authorized to practice under chapter 18.71A RCW.  The physician assistant member shall vote only on matters relating to the discipline of)) two additional physician members licensed under this chapter, five members of the public, and two physician assistants authorized under chapter 18.71A RCW.  The physician assistants shall vote only on matters relating to physician assistants.  The members of the board shall be appointed by the governor.  The governor may stagger initial terms of appointment and thereafter all terms of appointment shall be for four years.  The governor shall consider such physician and physician assistant members who are recommended for appointment by the appropriate professional associations in the state.  The members representing the public shall be persons whose occupations are other than the administration of health activities or the providing of health services, who have no fiduciary obligations to a health facility or other health agency, and who have no material financial interest in the rendering of health services.

    Nothing in this section shall affect the current terms of members of the board who are serving on the board on July 28, 1991.

    Vacancies on the board shall be filled promptly by the governor, and a member appointed to fill a vacancy on the board shall continue to serve until his or her successor is appointed.

    The terms of office of members of the board shall not be affected by changes in congressional district boundaries.

    The board shall be an administrative agency of the state of Washington.  The attorney general shall be the advisor to the board and shall represent it in legal proceedings.

    Sec. 45.  RCW 18.72.165 and 1986 c 300 s 5 are each amended to read as follows:

    (1) A licensed health care professional licensed under chapter 18.71 RCW shall report to the ((medical disciplinary)) board when he or she has personal knowledge that a practicing physician has either committed an act or acts which may constitute statutorily defined unprofessional conduct or that a practicing physician may be unable to practice medicine with reasonable skill and safety to patients by reason of illness, drunkenness, excessive use of drugs, narcotics, chemicals, or any other type of material, or as a result of any mental or physical conditions.

    (2) Reporting under this section is not required by:

    (a) An appropriately appointed peer review committee member of a licensed hospital or by an appropriately designated professional review committee member of a county or state medical society during the investigative phase of their respective operations if these investigations are completed in a timely manner; or

    (b) A treating licensed health care professional of a physician currently involved in a treatment program as long as the physician patient actively participates in the treatment program and the physician patient's impairment does not constitute a clear and present danger to the public health, safety, or welfare.

    (3) The ((medical disciplinary)) board may impose disciplinary sanctions, including license suspension or revocation, on any health care professional subject to the jurisdiction of the board who has failed to comply with this section.

    Sec. 46.  RCW 18.72.265 and 1986 c 259 s 117 are each amended to read as follows:

    (1) The contents of any report file under RCW 18.130.070 shall be confidential and exempt from public disclosure pursuant to chapter 42.17 RCW, except that it may be reviewed (a) by the licensee involved or his counsel or authorized representative who may submit any additional exculpatory or explanatory statements or other information, which statements or other information shall be included in the file, or (b) by a representative of the ((medical disciplinary)) board, or investigator thereof, who has been assigned to review the activities of a licensed physician.

    Upon a determination that a report is without merit, the board's records may be purged of information relating to the report.

    (2) Every individual, medical association, medical society, hospital, medical service bureau, health insurance carrier or agent, professional liability insurance carrier, professional standards review organization, and agency of the federal, state, or local government shall be immune from civil liability, whether direct or derivative, for providing information to the board subsequent to RCW 18.130.070, or for which an individual health care provider has immunity under the provisions of RCW 4.24.240, 4.24.250, or 4.24.260, as now or hereafter amended.

    Sec. 47.  RCW 18.72.340 and 1986 c 300 s 6 are each amended to read as follows:

    (1) Every institution or organization providing professional liability insurance to physicians shall send a complete report to the medical disciplinary board of all malpractice settlements, awards, or payments in excess of ((twenty)) fifty thousand dollars as a result of a claim or action for damages alleged to have been caused by an insured physician's incompetency or negligence in the practice of medicine.  Such institution or organization shall also report the award, settlement, or payment of three or more claims during a ((year)) three-year time period as the result of the alleged physician's incompetence or negligence in the practice of medicine regardless of the dollar amount of the award or payment.

    (2) Reports required by this section shall be made within sixty days of the date of the settlement or verdict.  Failure to comply with this section is punishable by a civil penalty not to exceed two hundred fifty dollars.

    Sec. 48.  RCW 18.72.380 and 1991 c 3 s 170 are each amended to read as follows:

    There is hereby levied to be collected by the department of health from every physician and surgeon licensed pursuant to chapter 18.71 RCW and every physician assistant licensed pursuant to chapter 18.71A RCW an annual medical disciplinary assessment equal to the license renewal fee established under RCW 43.70.250.  The assessment levied pursuant to this ((subsection)) section is in addition to any license renewal fee established under RCW 43.70.250.

    Sec. 49.  RCW 18.135.030 and 1991 c 3 s 273 are each amended to read as follows:

    The secretary, or the secretary's designee, with the advice of designees of the board of ((medical examiners)) medicine, the board of osteopathic medicine and surgery, the podiatry board, and the board of nursing, shall adopt rules necessary to administer, implement, and enforce this chapter and establish the minimum requirements necessary for a health care facility or health care practitioner to certify a health care assistant capable of performing the functions authorized in this chapter.  The rules shall establish minimum requirements for each and every category of health care assistant.  Said rules shall be adopted after fair consideration of input from representatives of each category.  These requirements shall ensure that the public health and welfare are protected and shall include, but not be limited to, the following factors:

    (1) The education and occupational qualifications for the health care assistant category;

    (2) The work experience for the health care assistant category;

    (3) The instruction and training provided for the health care assistant category; and

    (4) The types of drugs or diagnostic agents which may be administered by injection by health care assistants working in a hospital or nursing home.  The rules established pursuant to this subsection shall not prohibit health care assistants working in a health care facility other than a nursing home or hospital from performing the functions authorized under this chapter.

    Sec. 50.  RCW 18.135.055 and 1991 c 3 s 275 are each amended to read as follows:

    The health care facility or health care practitioner registering an initial or continuing certification pursuant to the provisions of this chapter shall pay a fee determined by the secretary as provided in RCW 43.70.250.  The secretary shall, to the extent possible, adjust certification fees among the different categories of health care assistants based upon the actual costs of disciplinary activities for each of the categories.

    All fees collected under this section shall be credited to the health professions account as required in RCW 43.70.320.

    Sec. 51.  RCW 18.135.070 and 1984 c 281 s 7 are each amended to read as follows:

    The licensing authority of health care facilities or the ((disciplinary board)) disciplining authority of the delegating or supervising health care practitioner shall investigate all complaints or allegations of violations of proper certification of a health care assistant or violations of delegation of authority or supervision.  A substantiated violation shall constitute sufficient cause for disciplinary action by the licensing authority of a health care facility or the ((disciplinary board)) disciplining authority of the health care practitioner.

NEW SECTION. Sec. 52.  A new section is added to chapter 18.135 RCW to read as follows:

    The uniform disciplinary act, chapter 18.130 RCW, governs uncertified practice, the issuance and denial of certificates, and the discipline of certificate holders under this chapter.  The secretary shall be the disciplining authority under this chapter.

    Sec. 53.  RCW 43.70.220 and 1989 1st ex.s. c 9 s 301 are each amended to read as follows:

    The powers and duties of the department of licensing and the director of licensing under the following statutes are hereby transferred to the department of health and the secretary of health:  Chapters 18.06, 18.19, 18.22, 18.25, ((18.26,)) 18.29, 18.32, 18.34, 18.35, 18.36A, 18.50, 18.52, ((18.52A, 18.52B,)) 18.52C, 18.53, 18.54, 18.55, 18.57, 18.57A, 18.59, 18.71, 18.71A, ((18.72,)) 18.74, 18.78, 18.83, 18.84, 18.88, 18.89, 18.92, 18.108, 18.135, and 18.138 RCW.  More specifically, the health professions regulatory programs and services presently administered by the department of licensing are hereby transferred to the department of health.

    Sec. 54.  RCW 69.41.030 and 1991 c 30 s 1 are each amended to read as follows:

    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 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 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 under chapter 18.88 RCW when authorized by the board of nursing, an osteopathic physician's assistant under chapter 18.57A RCW when authorized by the committee of osteopathic examiners, a physician assistant under chapter 18.71A RCW when authorized by the board of ((medical examiners)) medicine, a physician licensed to practice medicine and surgery or a physician licensed to practice osteopathy and surgery, a dentist licensed to practice dentistry, a podiatric physician and surgeon licensed to practice podiatric medicine and surgery, or a veterinarian licensed to practice veterinary medicine, in any province of Canada which shares a common border with the state of Washington or in any state of the United States:  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 warehouseman, 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 department of social and health services from selling, delivering, possessing, and dispensing commercially prepackaged oral contraceptives prescribed by authorized, licensed health care practitioners.

    Sec. 55.  RCW 69.45.010 and 1989 1st ex.s. c 9 s 444 are each amended to read as follows:

    The definitions in this section apply throughout this chapter.

    (1) "Board" means the board of pharmacy.

    (2) "Drug samples" means any federal food and drug administration approved controlled substance, legend drug, or products requiring prescriptions in this state, which is distributed at no charge to a practitioner by a manufacturer or a manufacturer's representative, exclusive of drugs under clinical investigations approved by the federal food and drug administration.

    (3) "Controlled substance" means a drug, substance, or immediate precursor of such drug or substance, so designated under or pursuant to chapter 69.50 RCW, the uniform controlled substances act.

    (4) "Deliver" or "delivery" means the actual, constructive, or attempted transfer from one person to another of a drug or device, whether or not there is an agency relationship.

    (5) "Dispense" means the interpretation of a prescription or order for a drug, biological, or device 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) "Distribute" means to deliver, other than by administering or dispensing, a legend drug.

    (7) "Legend drug" means any drug that is required by state law or by regulations of the board to be dispensed on prescription only or is restricted to use by practitioners only.

    (8) "Manufacturer" means a person or other entity engaged in the manufacture or distribution of drugs or devices, but does not include a manufacturer's representative.

    (9) "Person" means any individual, corporation, government or governmental subdivision or agency, business trust, estate, trust, partnership, association, or any other legal entity.

    (10) "Practitioner" means 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 ((podiatrist)) podiatric physician and surgeon under chapter 18.22 RCW, a veterinarian under chapter 18.92 RCW, a pharmacist under chapter 18.64 RCW, a commissioned medical or dental officer in the United States armed forces or the 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 under chapter 18.88 RCW when authorized to prescribe by the board of nursing, an osteopathic physician's assistant under chapter 18.57A RCW when authorized by the board of osteopathic medicine and surgery, or a physician's assistant under chapter 18.71A RCW when authorized by the board of ((medical examiners)) medicine.

    (11) "Manufacturer's representative" means an agent or employee of a drug manufacturer who is authorized by the drug manufacturer to possess drug samples for the purpose of distribution in this state to appropriately authorized health care practitioners.

    (12) "Reasonable cause" means a state of facts found to exist that would warrant a reasonably intelligent and prudent person to believe that a person has violated state or federal drug laws or regulations.

    (13) "Department" means the department of health.

    (14) "Secretary" means the secretary of health or the secretary's designee.

    Sec. 56.  RCW 74.42.230 and 1982 c 120 s 2 are each amended to read as follows:

    (1) The resident's attending or staff physician or authorized practitioner approved by the attending physician shall order all medications for the resident.  The order may be oral or written and shall be limited by time.  An "authorized practitioner," as used in this section, is a registered nurse under chapter 18.88 RCW when authorized by the board of nursing, an osteopathic physician's assistant under chapter 18.57A RCW when authorized by the committee of osteopathic examiners, or a physician's assistant under chapter 18.71A RCW when authorized by the board of ((medical examiners)) medicine.

    (2) An oral order shall be given only to a licensed nurse, pharmacist, or another physician.  The oral order shall be recorded and signed immediately by the person receiving the order.  The attending physician shall sign the record of the oral order in a manner consistent with good medical practice.

NEW SECTION. Sec. 57.  A new section is added to chapter 34.05 RCW under the subchapter heading "judicial review and civil enforcement" to read as follows:

    Unless the context clearly indicates otherwise, for the purposes of rules review committee oversight, "rule" means guidelines, interpretive statements, policy statements, declaratory judgments whether binding or nonbinding, advisory opinions, or any other orders of an administrative agency meant to state the official position of the agency on a matter within its jurisdiction that affects a class of persons.

NEW SECTION. Sec. 58.  The secretary shall report to the health policy committees of the legislature concerning implementation of this act no later than December 1, 1993.

NEW SECTION. Sec. 59.  The board of funeral directors and embalmers shall report to the health policy committees of the legislature by November 15, 1993, with recommendations for incorporation of the applicable provisions of chapter 18.130 RCW into chapter 18.39 RCW.

NEW SECTION. Sec. 60.  The following acts or parts of acts are each repealed:

(1) RCW 18.25.015 and 1989 c 258 s 1, 1984 c 279 s 49, 1980 c 51 s 1, 1965 ex.s. c 50 s 1, & 1959 c 53 s 1;

(2) RCW 18.25.016 and 1989 c 258 s 13;

(3) RCW 18.25.017 and 1991 c 3 s 37, 1986 c 259 s 23, 1984 c 287 s 27, 1975-'76 2nd ex.s. c 34 s 32, 1974 ex.s. c 97 s 8, & 1959 c 53 s 2;

(4) RCW 18.26.010 and 1989 c 258 s 7 & 1967 c 171 s 1;

(5) RCW 18.26.020 and 1991 c 3 s 43, 1989 c 258 s 8, & 1967 c 171 s 2;

(6) RCW 18.26.028 and 1987 c 150 s 13 & 1986 c 259 s 22;

(7) RCW 18.26.110 and 1986 c 259 s 26, 1975 1st ex.s. c 39 s 2, & 1967 c 171 s 11;

(8) RCW 18.26.900 and 1967 c 171 s 31;

(9) RCW 18.32.035 and 1989 c 202, s 14, 1984 c 279 s 50, 1979 c 38 s 1, 1975 c 49 s 1, 1953 c 93 s 2, 1941 c 92 s 1, & 1935 c 112 s 2;

(10) RCW 18.32.037 and 1991 c 3 s 60, 1989 c 202 s 15, & 1935 c 112 s 3;

(11) RCW 18.32.042 and 1989 c 202 s 28;

(12) RCW 18.32.050 and 1984 c 287 s 30, 1979 c 38 s 3, 1975-'76 2nd ex.s. c 34 s 34, 1967 c 188 s 2, 1957 c 52 s 23, & 1953 c 93 s 3;

(13) RCW 18.32.500 and 1989 c 202 s 24, 1986 c 259 s 39, & 1977 ex.s. c 5 s 37;

(14) RCW 18.32.510 and 1977 ex.s. c 5 s 1;

(15) RCW 18.32.520 and 1991 c 3 s 71, 1989 c 202 s 25, 1986 c 259 s 40, 1979 c 158 s 36, & 1977 ex.s. c 5 s 2;

(16) RCW 18.32.530 and 1989 c 202 s 26, 1986 c 259 s 41, & 1977 ex.s. c 5 s 3;

(17) RCW 18.32.534 and 1991 c 3 s 72 & 1989 c 125 s 1;

(18) RCW 18.32.665 and 1986 c 259 s 36 & 1935 c 112 s 20;

(19) RCW 18.32.745 and 1991 c 3 s 73, 1977 ex.s. c 5 s 31, 1957 c 52 s 38, & 1953 c 93 s 7;

(20) RCW 18.64.260 and 1987 c 202 s 184, 1969 ex.s. c 199 s 17, 1909 c 213 s 9, & 1899 c 121 s 17;

(21) RCW 18.71.015 and 1991 c 44 s 1, 1991 c 3 s 159, 1990 c 196 s 11, 1987 c 116 s 1, 1984 c 287 s 44, 1979 c 158 s 52, 1975-'76 2nd ex.s. c 34 s 41, 1975 1st ex.s. c 171 s 2, & 1961 c 284 s 2;

(22) RCW 18.71A.070 and 1990 c 196 s 7, 1979 c 158 s 58, & 1975 1st ex.s. c 190 s 3;

(23) RCW 18.72.010 and 1955 c 202 s 1;

(24) RCW 18.72.020 and 1986 c 259 s 115 & 1955 c 202 s 2;

(25) RCW 18.72.150 and 1986 c 259 s 116, 1979 ex.s. c 111 s 5, 1975 c 61 s 4, & 1955 c 202 s 15;

(26) RCW 18.72.154 and 1986 c 259 s 107;

(27) RCW 18.72.155 and 1991 c 3 s 168 & 1979 ex.s. c 111 s 6;

(28) RCW 18.72.190 and 1989 c 373 s 18 & 1955 c 202 s 19;

(29) RCW 18.72.301 and 1989 c 119 s 1 & 1987 c 416 s 1;

(30) RCW 18.72.306 and 1991 c 3 s 169, 1989 c 119 s 2, & 1987 c 416 s 2;

(31) RCW 18.72.311 and 1987 c 416 s 3;

(32) RCW 18.72.316 and 1987 c 416 s 4;

(33) RCW 18.72.321 and 1987 c 416 s 6;

(34) RCW 18.72.390 and 1991 sp.s. c 13 s 17, 1985 c 57 s 6, & 1983 c 71 s 2;

(35) RCW 18.72.400 and 1991 c 3 s 171 & 1983 c 71 s 3;

(36) RCW 18.72.900 and 1955 c 202 s 46;

(37) RCW 18.72.910 and 1955 c 202 s 48;

(38) RCW 18.135.080 and 1991 c 3 s 277 & 1984 c 281 s 8;

(39) RCW 43.131.337 and 1987 c 160 s 2; and

(40) RCW 43.131.338 and 1987 c 160 s 3.

NEW SECTION. Sec. 61.  RCW 18.26.030, 18.26.040, 18.26.050, 18.26.070, 18.26.080, 18.26.090, 18.26.320, 18.26.330, 18.26.340, 18.26.350, 18.26.360, 18.26.370, 18.26.380, and 18.26.390 are each recodified as sections in chapter 18.25 RCW.  RCW 18.72.045, 18.72.090, 18.72.100, 18.72.110, 18.72.130, 18.72.165, 18.72.265, 18.72.340, 18.72.345, 18.72.350, and 18.72.360 are each recodified as sections in chapter 18.71 RCW.

NEW SECTION. Sec. 62.  Captions as used in this act constitute no part of the law.

NEW SECTION. Sec. 63.  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."

EHB 1256 - S COMM AMD

By Committee on Health & Human Services

    On page 1, line 1 of the title, after "professionals;" strike the remainder of the title and insert "amending RCW 18.130.010, 18.130.040, 18.130.050, 18.130.060, 18.130.090, 18.130.160, 18.130.165, 18.130.175, 18.130.185, 18.130.186, 18.130.190, 18.130.300, 18.25.005, 18.25.006, 18.25.019, 18.25.020, 18.25.030, 18.25.040, 18.25.070, 18.25.190, 18.26.030, 18.26.040, 18.26.390, 18.32.010, 18.32.030, 18.32.195, 18.32.560, 18.32.655, 18.50.115, 18.64.160, 18.64A.050, 18.71.010, 18.71.019, 18.71.095, 18.71.205, 18.71.230, 18.71A.010, 18.72.045, 18.72.165, 18.72.265, 18.72.340, 18.72.380, 18.135.030, 18.135.055, 18.135.070, 43.70.220, 69.41.030, 69.45.010, and 74.42.230; reenacting and amending RCW 18.130.180 and 18.71.030; adding new sections to chapter 18.130 RCW; adding a new section to chapter 18.64 RCW; adding a new section to chapter 18.64A RCW; adding a new section to chapter 18.135 RCW; adding a new section to chapter 34.05 RCW; adding new sections to chapter 18.25 RCW; adding new sections to chapter 18.71 RCW; creating new sections; recodifying RCW 18.26.030, 18.26.040, 18.26.050, 18.26.070, 18.26.080, 18.26.090, 18.26.320, 18.26.330, 18.26.340, 18.26.350, 18.26.360, 18.26.370, 18.26.380, 18.26.390, 18.72.045, 18.72.090, 18.72.100, 18.72.110, 18.72.130, 18.72.165, 18.72.265, 18.72.340, 18.72.345, 18.72.350, and 18.72.360; and repealing RCW 18.25.015, 18.25.016, 18.25.017, 18.26.010, 18.26.020, 18.26.028, 18.26.110, 18.26.900, 18.32.035, 18.32.037, 18.32.042, 18.32.050, 18.32.500, 18.32.510, 18.32.520, 18.32.530, 18.32.534, 18.32.665, 18.32.745, 18.64.260, 18.71.015, 18.71A.070, 18.72.010, 18.72.020, 18.72.150, 18.72.154, 18.72.155, 18.72.190, 18.72.301, 18.72.306, 18.72.311, 18.72.316, 18.72.321, 18.72.390, 18.72.400, 18.72.900, 18.72.910, 18.135.080, 43.131.337, and 43.131.338."

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