5859-S2

AN ACT Relating to the regulation of health professions; amending RCW 18.120.020, 18.130.010, 18.130.040, 18.130.060, 18.71.019, 18.19.070, 18.71.010, 18.71.017, 18.71.019, 18.71.050, 18.71.051, 18.71.055, 18.71.060, 18.71.070, 18.71.085, 18.71.090, 18.71.095, 18.71.205, 18.71.230, 18.71A.010, 18.71A.020, 18.71A.030, 18.71A.040, 18.71A.045, 18.71A.050, 18.71A.060, 18.71A.085, 18.72.155, 18.72.165, 18.72.265, 18.72.301, 18.72.306, 18.72.311, 18.72.316, 18.72.340, 18.72.345, 18.25.005, 18.25.006, 18.25.019, 18.25.020, 18.25.025, 18.25.030, 18.25.035, 18.25.040, 18.25.070, 18.25.075, 18.25.180, 18.25.190, 18.32.010, 18.32.030, 18.32.040, 18.32.050, 18.32.100, 18.32.120, 18.32.160, 18.32.180, 18.32.190, 18.32.195, 18.32.215, 18.32.534, 18.32.640, 18.32.655, 18.32.665, 18.32.745, and 18.32.755; reenacting and amending RCW 18.130.050, 18.71.015, 18.71.030, and 18.71.080; adding a new section to chapter 18.122 RCW; adding new sections to chapter 18.130 RCW; adding a new section to chapter 18.06 RCW; adding a new section to chapter 18.19 RCW; adding a new section to chapter 18.22 RCW; adding new sections to chapter 18.25 RCW; adding a new section to chapter 18.29 RCW; adding new sections to chapter 18.32 RCW; adding a new section to chapter 18.34 RCW; adding a new section to chapter 18.35 RCW; adding a new section to chapter 18.36A RCW; adding a new section to chapter 18.50 RCW; adding a new section to chapter 18.52 RCW; adding a new section to chapter 18.52C RCW; adding a new section to chapter 18.53 RCW; adding a new section to chapter 18.54 RCW; adding a new section to chapter 18.55 RCW; adding a new section to chapter 18.57 RCW; adding a new section to chapter 18.57A RCW; adding a new section to chapter 18.59 RCW; adding a new section to chapter 18.64 RCW; adding a new section to chapter 18.64A RCW; adding new sections to chapter 18.71 RCW; adding a new section to chapter 18.71A RCW; adding a new section to chapter 18.73 RCW; adding a new section to chapter 18.74 RCW; adding a new section to chapter 18.83 RCW; adding a new section to chapter 18.84 RCW; adding a new section to chapter 18.88A RCW; adding a new section to chapter 18.89 RCW; adding a new section to chapter 18.92 RCW; adding a new section to chapter 18.135 RCW; adding a new section to chapter 18.155 RCW; adding a new section to chapter 18.138 RCW; adding a new section to chapter 18.108 RCW; adding a new section to chapter 34.05 RCW; adding new chapters to Title 18 RCW; creating new sections; recodifying RCW 18.72.155, 18.72.165, 18.72.265, 18.72.301, 18.72.306, 18.72.311, 18.72.316, 18.72.340, 18.72.345, 18.72.010, 18.72.321, 18.25.130, 18.25.140, 18.25.150, 18.25.160, and 18.25.170; and repealing RCW 18.78.005, 18.78.010, 18.78.020, 18.78.030, 18.78.040, 18.78.050, 18.78.054, 18.78.055, 18.78.058, 18.78.060, 18.78.070, 18.78.072, 18.78.080, 18.78.090, 18.78.100, 18.78.160, 18.78.182, 18.78.225, 18.78.900, 18.78.901, 18.88.010, 18.88.020, 18.88.030, 18.88.050, 18.88.060, 18.88.070, 18.88.080, 18.88.086, 18.88.090, 18.88.100, 18.88.110, 18.88.120, 18.88.130, 18.88.140, 18.88.150, 18.88.160, 18.88.170, 18.88.175, 18.88.190, 18.88.200, 18.88.220, 18.88.270, 18.88.280, 18.88.285, 18.88.290, 18.88.295, 18.88.300, 18.88.900, 18.88A.070, 18.72.020, 18.72.045, 18.72.090, 18.72.100, 18.72.110, 18.72.120, 18.72.130, 18.72.150, 18.72.154, 18.72.190, 18.72.380, 18.72.390, 18.72.400, 18.72.900, 18.72.910, 18.25.015, 18.25.016, 18.25.017, 18.25.120, 18.26.010, 18.26.020, 18.26.028, 18.26.030, 18.26.040, 18.26.050, 18.26.060, 18.26.070, 18.26.080, 18.26.090, 18.26.110, 18.26.320, 18.26.330, 18.26.340, 18.26.350, 18.26.360, 18.26.370, 18.26.380, 18.26.390, 18.26.900, 18.32.035, 18.32.037, 18.32.042, 18.32.500, 18.32.510, 18.32.520, 18.32.560, 18.32.570, 18.32.580, 18.32.590, 18.32.600, 18.32.610, and 18.32.620.

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

TABLE OF CONTENTS

PART I - AUTHORITY OVER SCOPE OF PRACTICE

OF STATE-REGULATED HEALTH PROFESSIONALS.................................................... 3

PART II - REVISIONS OF THE HEALTH PROFESSIONAL

"SUNRISE" REVIEW PROCESS.......................................................................... 9

PART III - CREATING A UNIFORM AND CONSISTENTLY APPLIED DISCIPLINARY

PROCESS UNDER THE UNIFORM DISCIPLINARY ACT.................................................. 11

PART IV - TECHNICAL CHANGES TO THE

HEALTH PROFESSIONAL PRACTICE ACTS............................................................. 16

PART V - NURSING AND MENTAL HEALTH............................................................................................................................. 24

PART VI - MEDICAL, CHIROPRACTIC, AND DENTAL............................................................................................................. 44

PART VII - TIMELINES....................................................................................................................................................................... 92

PART VIII - MISCELLANEOUS......................................................................................................................................................... 93

PART I - AUTHORITY OVER SCOPE OF PRACTICE

OF STATE-REGULATED HEALTH PROFESSIONALS

NEW SECTION. Sec. 101. LEGISLATIVE INTENT. The legislature finds that regulation of health professions is an important part of state quality assurance activities that help assure the safe delivery of health care services to the people of this state.

It further finds that there are twenty separate regulatory authorities that govern the health professions and act on scope of practice decisions. The large number of regulatory authorities has sometimes resulted in inconsistent and conflicting regulation of the state's health professions including expansions in scopes of practice beyond legislative intent. In addition, scopes of practice between some professions overlap and it is often unclear which regulatory authority has jurisdiction. Separate authorities may adopt conflicting rules concerning the same scope of practice issue. The legislature is often requested to resolve these interprofessional conflicts.

The legislature further finds that it is requested to consider legislation to increase the level of regulation of health professions already regulated by the state. Increasing the level of regulation further restricts the practice of the profession by requiring individuals to obtain specialized training and pass a credentialing examination. These requests require a determination that the existing level of regulation is insufficient to protect the public from the unsafe practice of the profession.

The legislature declares that the best forum for deciding such changes in scope of practice and levels of health professional credentialing is through a nonpolitical process that allows for a more deliberative and objective consideration of such changes. The expertise of the existing health professional licensing boards and advisory committees should be used in considering such changes but a single authority should be responsible for making decisions on changes in scope of practice or the level of credentialing.

The legislature further finds that the system for determining the level of regulation, the scopes of practice and credentialing levels for health care professionals, will require intensive review and careful professional judgment to enable reform to occur concurrently with other changes in the health care delivery system in the state of Washington and in the nation as a whole. This process may need to examine the cost and efficiency of the present process to insure that it provides the most professional collaboration and interdependence and includes an adequate representation from nonprofessionals on credentialing and disciplinary bodies.

NEW SECTION. Sec. 102. DEFINITIONS. The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.

(1) "Credential" means regulation of a health professional at the level of registration, certification, or licensure as defined in chapter 18.120 RCW.

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

(3) "Health profession" means a health profession specified under RCW 18.130.040(2).

(4) "Health profession advisory committee" or "advisory committee" means advisory committees established by the secretary or by law for health professions cited in RCW 18.130.040(2)(a).

(5) "Health profession regulatory board" or "boards" or "commissions" means the professional regulatory boards or commissions for health professions cited in RCW 18.130.040(2)(b).

(6) "Scope of practice" means the range of diagnosis, treatments, services, technologies, equipment, and pharmaceuticals that a health profession is authorized to use.

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

NEW SECTION. Sec. 103. APPLICABILITY. Except for licensees governed under chapter 18.39 RCW, the professional review commission shall have the authority to adopt rules, standards, guidelines, or policies relating to the scope of practice or the level of credentialing for health professions regulated under RCW 18.130.040 in accordance with provisions of this chapter.

NEW SECTION. Sec. 104. PROFESSIONAL REVIEW COMMISSION AND LEVEL OF CREDENTIALING REVIEW PROCESS. (1) A professional review commission is created within the department of health. The commission shall be composed of six members, of whom one is the state health officer who shall chair the committee. The remaining five shall be appointed by the governor, with the consent of the senate. These members must demonstrate a broad understanding of health care issues and a commitment to improving the delivery of health care to all citizens in Washington state.

(2)(a) Initial commission members shall serve four-year terms. The term of office for commission members after the initial commission is three years, with the first appointments staggered, two members appointed for one year, two members appointed for two years, and two members appointed for three years. Thereafter, members shall be appointed for three-year terms. A commission member may be removed for just cause including a finding of fact or more than three unexcused absences. The governor may appoint a new member to fill a vacancy on the commission for the remainder of the unexpired term.

(b) No commission member appointed by the governor may serve more than two consecutive terms, whether full or partial.

(3) Commission members who are nonstate employees shall be reimbursed for travel expenses in accordance with RCW 43.03.050 and 43.03.060.

(4) Members of the commission appointed by the governor shall not have current licenses to practice in any of the professions subject to regulation and shall have no pecuniary interest in any business subject to regulation by the commission. Members shall be subject to chapter 42.18 RCW, the executive branch conflict of interest act.

(5) The commission shall:

(a) Receive applications from new professions seeking credentialing and make recommendations to the legislature concerning whether a profession should be credentialed.

(b) Authorize the level of credentialing and specify scope of practice for new professions.

(c) Review requests for changes in scope of practice or level of credentialing for health professions regulated under RCW 18.130.040 in accordance with provisions of this chapter.

(d) Require that a party requesting changes in scope of practice or level of credentialing submit information relevant to such decisions pursuant to chapter 18.120 RCW.

(e) Direct staff at the department to conduct an analysis of the request for change in scope of practice, or a level of credentialing, using a fair and impartial review of the facts, and authorize that the application be granted or denied based on criteria outlined in RCW 18.120.030. In the event that an application is deemed frivolous by the professional review commission, the applicant will be charged the cost of processing and reviewing the request.

(f) Review the rules and other decisions of the health professional regulatory boards to determine whether such rules or decisions have the effect of altering the scope of practice of that profession. If the professional review commission deems that a board has acted in a manner to change a scope of practice, the commission may reverse, vacate, revoke, nullify, or modify the rules or decisions. All rules, standards, guidelines, or policies of any kind relating to a profession's scope of practice of a health profession regulatory board, whether adopted before or after the effective date of this act, are subject to review by the professional review commission.

(g) Authorize changes be made in training, education, and other requirements for health professions specified under RCW 18.130.040 to enable changes in scope of practice or levels of credentialing that are authorized under this chapter. This shall include, when appropriate, adoption of uniform provisions under chapter 18.122 RCW.

(h) Use the professional expertise of the health profession regulatory boards, health profession regulatory commissions, and advisory committees and others to fulfill its responsibilities under this chapter.

(i) Use expert witnesses when expertise on a specific application is needed.

NEW SECTION. Sec. 105. AUGMENT OR REMOVE. (1) Effective July 1, 1995, the professional review commission may augment or remove functions of a health profession's scope of practice or make changes in the level of credentialing of a health profession.

(2) The professional review commission, notwithstanding any provision of this title to the contrary, shall establish additional training, education, and other requirements for health professions specified under RCW 18.130.040 as made necessary by the changes in scope of practice or levels of credentialing or professions newly credentialed that are authorized under this chapter. This shall include, when appropriate, application of uniform administrative provisions under chapter 18.122 RCW. In the event that a rule by the professional review commission directly conflicts with statutory provisions in this title, the commission shall submit for legislative consideration, proposed legislation that would remove statutory conflict.

(3) All processes by the professional review commission under this chapter shall be subject to the provisions of chapter 34.05 RCW.

(4) Rules adopted by the professional review commission under this section are subject to review by the joint administrative rules review committee of the legislature. If the joint administrative rules review committee does not direct the professional review commission to reconsider the rule within forty-five days of publication, the rule is deemed effective.

NEW SECTION. Sec. 106. CRITERIA FOR USE BY THE PROFESSIONAL REVIEW COMMISSION. (1) In considering changes in the scope of practice of a health profession, the professional review commission shall consider at least the following factors:

(a) Whether a serious risk to the public's life, health, or safety will occur if the scope of practice remains unchanged.

(b) Whether there is a clear benefit to the public in changing the scope of practice of a health profession.

(c) Whether the current education and training requirements of the health profession are sufficient to assure the safe delivery of the health care services that will result from the change of scope of practice.

(d) Whether there is a sufficient availability of training and education programs to meet the demand for training that will result from the change in scope of practice.

(e) How the change in the scope of practice will effect the availability and cost of health care services.

(f) Whether the change in level of credentialing, or scope of practice improves access and affordability to health care services with proven success in promoting public health.

(2) In considering changes in the level of credentialing of a health profession cited in RCW 18.130.040(2), the professional review commission shall consider at a minimum the criteria specified in chapter 18.120 RCW.

NEW SECTION. Sec. 107. A new section is added to chapter 18.122 RCW to read as follows:

TRANSITION AND STUDY. (1) The department shall establish a health care governance project. Participants in this project shall be determined by the secretary. The secretary is encouraged to include representatives from boards and commissions, health professions resource plan statutory committee, health care providers, insurers, the public, the legislature, higher education, the health services commission, and other appropriate state agencies dealing with health systems reform. A report to the legislature shall be submitted by the project by December 1, 1995. The report shall include timelines for implementation and proposed language for consideration in the 1996 legislative session.

(2) The purpose of the project is to recommend further improvements to the system for the credentialing and disciplining of health professionals in the state of Washington.

NEW SECTION. Sec. 108. CODIFICATION INSTRUCTIONS. Sections 101 through 106 of this act shall constitute a new chapter in Title 18 RCW.

PART II - REVISIONS OF THE HEALTH PROFESSIONAL

"SUNRISE" REVIEW PROCESS

Sec. 201. RCW 18.120.020 and 1989 c 300 s 14 are each amended to read as follows:

The definitions contained in this section shall apply throughout this chapter unless the context clearly requires otherwise.

(1) "Applicant group" includes any health professional group or organization, any individual, or any other interested party which proposes that any health professional group not presently regulated be regulated or which proposes to substantially increase the scope of practice of the profession.

(2) "Certificate" and "certification" mean a voluntary process by which a statutory regulatory entity grants recognition to an individual who (a) has met certain prerequisite qualifications specified by that regulatory entity, and (b) may assume or use "certified" in the title or designation to perform prescribed health professional tasks.

(3) "Grandfather clause" means a provision in a regulatory statute applicable to practitioners actively engaged in the regulated health profession prior to the effective date of the regulatory statute which exempts the practitioners from meeting the prerequisite qualifications set forth in the regulatory statute to perform prescribed occupational tasks.

(4) "Health professions" means and includes the following health and health-related licensed or regulated professions and occupations: ((~~Podiatry~~)) Podiatric medicine and surgery under chapter 18.22 RCW; chiropractic under chapter((s)) 18.25 ((~~and 18.26~~)) RCW; dental hygiene under chapter 18.29 RCW; dentistry under chapter 18.32 RCW; dispensing opticians under chapter 18.34 RCW; hearing aids under chapter 18.35 RCW; naturopaths under chapter 18.36A RCW; embalming and funeral directing under chapter 18.39 RCW; midwifery under chapter 18.50 RCW; nursing home administration under chapter 18.52 RCW; optometry under chapters 18.53 and 18.54 RCW; ocularists under chapter 18.55 RCW; osteopathy and osteopathic medicine and surgery under chapters 18.57 and 18.57A RCW; pharmacy under chapters 18.64 and 18.64A RCW; medicine under chapters 18.71((,)) and 18.71A((~~, and 18.72~~)) RCW; emergency medicine under chapter 18.73 RCW; physical therapy under chapter 18.74 RCW; practical nurses under chapter 18.78 RCW; psychologists under chapter 18.83 RCW; registered nurses under chapter 18.88 RCW; occupational therapists licensed pursuant to chapter 18.59 RCW; respiratory care practitioners certified under chapter 18.89 RCW; veterinarians and animal technicians under chapter 18.92 RCW; health care assistants under chapter 18.135 RCW; massage practitioners under chapter 18.108 RCW; acupuncturists certified under chapter 18.06 RCW; persons registered or certified under chapter 18.19 RCW; dietitians and nutritionists certified by chapter 18.138 RCW; radiologic technicians under chapter 18.84 RCW; and nursing assistants registered or certified under chapter 18.88A RCW.

(5) "Inspection" means the periodic examination of practitioners by a state agency in order to ascertain whether the practitioners' occupation is being carried out in a fashion consistent with the public health, safety, and welfare.

(6) "Legislative committees of reference" means the standing legislative committees designated by the respective rules committees of the senate and house of representatives to consider proposed legislation to regulate health professions not previously regulated.

(7) "License," "licensing," and "licensure" mean permission to engage in a health profession which would otherwise be unlawful in the state in the absence of the permission. A license is granted to those individuals who meet prerequisite qualifications to perform prescribed health professional tasks and for the use of a particular title.

(8) "Professional license" means an individual, nontransferable authorization to carry on a health activity based on qualifications which include: (a) Graduation from an accredited or approved program, and (b) acceptable performance on a qualifying examination or series of examinations.

(9) "Practitioner" means an individual who (a) has achieved knowledge and skill by practice, and (b) is actively engaged in a specified health profession.

(10) "Public member" means an individual who is not, and never was, a member of the health profession being regulated or the spouse of a member, or an individual who does not have and never has had a material financial interest in either the rendering of the health professional service being regulated or an activity directly related to the profession being regulated.

(11) "Registration" means the formal notification which, prior to rendering services, a practitioner shall submit to a state agency setting forth the name and address of the practitioner; the location, nature and operation of the health activity to be practiced; and, if required by the regulatory entity, a description of the service to be provided.

(12) "Regulatory entity" means any board, commission, agency, division, or other unit or subunit of state government which regulates one or more professions, occupations, industries, businesses, or other endeavors in this state.

(13) "State agency" includes every state office, department, board, commission, regulatory entity, and agency of the state, and, where provided by law, programs and activities involving less than the full responsibility of a state agency.

PART III - CREATING A UNIFORM AND CONSISTENTLY APPLIED DISCIPLINARY

PROCESS UNDER THE UNIFORM DISCIPLINARY ACT

Sec. 301. 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.

NEW SECTION. Sec. 302. A new section is added to chapter 18.130 RCW to read as follows:

UNIFORM APPLICATION OF THE UNIFORM DISCIPLINARY ACT. By July 1, 1995, the secretary, in consultation with the regulatory boards under RCW 18.130.040, shall establish procedures and criteria in rule for the consistent application of this chapter to all persons subject to this chapter. This shall include but not be limited to assuring consistency and uniformity in determining whether complaints merit investigation, conducting complaint investigations, determining when an action by the complainant constitutes unlicensed practice, unprofessional conduct or unsafe practice, and assessing sanctions against individuals for violation of the provisions of this chapter.

Sec. 303. RCW 18.130.040 and 1993 c 367 s 4 are each amended to read as follows:

(1) This chapter applies only to the secretary and the boards and commissions having jurisdiction in relation to the professions licensed under the chapters specified in this section. This chapter does not apply to any business or profession not licensed under the chapters specified in this section.

(2)(a) The secretary has authority under this chapter in relation to the following professions:

(i) Dispensing opticians licensed 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 and x-ray technicians certified 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 18.88A RCW;

(xiii) Health care assistants certified under chapter 18.135 RCW;

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

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

(xvi) Persons licensed and certified under chapter 18.73 RCW or RCW 18.71.205.

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

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

(ii) The chiropractic ((~~disciplinary board~~)) quality assurance commission as established in ((~~chapter 18.26 RCW governing licenses issued under~~)) chapter 18.25 RCW;

(iii) The dental ((~~disciplinary board~~)) quality assurance commission 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 board of pharmacy as established in chapter 18.64 RCW governing licenses issued under chapters 18.64 and 18.64A RCW;

(x) The medical ((~~disciplinary board~~)) quality assurance commission as established in chapter ((~~18.72~~)) 18.71 RCW governing licenses and registrations issued under chapters 18.71 and 18.71A RCW;

(xi) The board of physical therapy as established in chapter 18.74 RCW;

(xii) The board of occupational therapy practice as established in chapter 18.59 RCW;

(xiii) ((~~The board of practical nursing as established in chapter 18.78 RCW;~~

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

((~~(xv)~~)) (xiv) The ((~~board of~~)) nursing care quality assurance commission as established in ((~~chapter 18.88 RCW~~)) sections 501 through 531 of this act; and

((~~(xvi)~~)) (xv) The veterinary board of governors as established in chapter 18.92 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. 304. RCW 18.130.050 and 1993 c 367 s 21 and 1993 c 367 s 5 are each reenacted and 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 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 the appropriate records and otherwise facilitate the review and audit. Information so gained shall not be subject to discovery or introduction into evidence in any civil action pursuant to RCW 70.41.200(3) and shall be exempt from public disclosure under chapter 42.17 RCW.

Sec. 305. 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.

(5) In consultation with the disciplinary authorities, to adopt uniform procedural rules that shall be used for all adjudicative proceedings conducted under this chapter, as defined by chapter 34.05 RCW. The rules shall address the use of a presiding officer designated by the secretary, to determine legal issues arising during adjudicative proceedings.

PART IV - TECHNICAL CHANGES TO THE

HEALTH PROFESSIONAL PRACTICE ACTS

NEW SECTION. Sec. 401. A new section is added to chapter 18.06 RCW to read as follows:

ACUPUNCTURE‑-APPLICATION OF SCOPE OF PRACTICE AUTHORITY. The professional review commission shall have the authority to adopt rules, standards, guidelines, or judgments relating to the scope of practice of the profession regulated under this chapter in accordance with the provisions of chapter 18.-- RCW (sections 101 through 106 of this act).

NEW SECTION. Sec. 402. A new section is added to chapter 18.19 RCW to read as follows:

COUNSELORS‑-APPLICATION OF SCOPE OF PRACTICE AUTHORITY. The professional review commission shall have the authority to adopt rules, standards, guidelines, or judgments relating to the scope of practice of the professions regulated under this chapter in accordance with the provisions of chapter 18.-- RCW (sections 101 through 106 of this act).

NEW SECTION. Sec. 403. A new section is added to chapter 18.22 RCW to read as follows:

PODIATRIC PHYSICIANS AND SURGEONS‑-APPLICATION OF SCOPE OF PRACTICE AUTHORITY. The professional review commission shall have the authority to adopt rules, standards, guidelines, or judgments relating to the scope of practice of the profession regulated under this chapter in accordance with the provisions of chapter 18.-- RCW (sections 101 through 106 of this act).

NEW SECTION. Sec. 404. A new section is added to chapter 18.25 RCW to read as follows:

CHIROPRACTIC‑-APPLICATION OF SCOPE OF PRACTICE AUTHORITY. The professional review commission shall have the authority to adopt rules, standards, guidelines, or judgments relating to the scope of practice of the profession regulated under this chapter in accordance with the provisions of chapter 18.-- RCW (sections 101 through 106 of this act).

NEW SECTION. Sec. 405. A new section is added to chapter 18.29 RCW to read as follows:

DENTAL HYGIENE‑-APPLICATION OF SCOPE OF PRACTICE AUTHORITY. The professional review commission shall have the authority to adopt rules, standards, guidelines, or judgments relating to the scope of practice of the profession regulated under this chapter in accordance with the provisions of chapter 18.-- RCW (sections 101 through 106 of this act).

NEW SECTION. Sec. 406. A new section is added to chapter 18.32 RCW to read as follows:

DENTISTS‑-APPLICATION OF SCOPE OF PRACTICE AUTHORITY. The professional review commission shall have the authority to adopt rules, standards, guidelines, or judgments relating to the scope of practice of the profession regulated under this chapter in accordance with the provisions of chapter 18.-- RCW (sections 101 through 106 of this act).

NEW SECTION. Sec. 407. A new section is added to chapter 18.34 RCW to read as follows:

DISPENSING OPTICIANS‑-APPLICATION OF SCOPE OF PRACTICE AUTHORITY. The professional review commission shall have the authority to adopt rules, standards, guidelines, or judgments relating to the scope of practice of the professions regulated under this chapter in accordance with the provisions of chapter 18.-- RCW (sections 101 through 106 of this act).

NEW SECTION. Sec. 408. A new section is added to chapter 18.35 RCW to read as follows:

HEARINGS AIDS‑-APPLICATION OF SCOPE OF PRACTICE AUTHORITY. The professional review commission shall have the authority to adopt rules, standards, guidelines, or judgments relating to the scope of practice of the profession regulated under this chapter in accordance with the provisions of chapter 18.-- RCW (sections 101 through 106 of this act).

NEW SECTION. Sec. 409. A new section is added to chapter 18.36A RCW to read as follows:

NATUROPATHY‑-APPLICATION OF SCOPE OF PRACTICE AUTHORITY. The professional review commission shall have the authority to adopt rules, standards, guidelines, or judgments relating to the scope of practice of the profession regulated under this chapter in accordance with the provisions of chapter 18.-- RCW (sections 101 through 106 of this act).

NEW SECTION. Sec. 410. A new section is added to chapter 18.50 RCW to read as follows:

MIDWIVES‑-APPLICATION OF SCOPE OF PRACTICE AUTHORITY. The professional review commission shall have the authority to adopt rules, standards, guidelines, or judgments relating to the scope of practice of the profession regulated under this chapter in accordance with the provisions of chapter 18.-- RCW (sections 101 through 106 of this act).

NEW SECTION. Sec. 411. A new section is added to chapter 18.52 RCW to read as follows:

NURSING HOME ADMINISTRATORS‑-APPLICATION OF SCOPE OF PRACTICE AUTHORITY. The professional review commission shall have the authority to adopt rules, standards, guidelines, or judgments relating to the scope of practice of the profession regulated under this chapter in accordance with the provisions of chapter 18.-- RCW (sections 101 through 106 of this act).

NEW SECTION. Sec. 412. A new section is added to chapter 18.52C RCW to read as follows:

NURSING POOLS‑-APPLICATION OF SCOPE OF PRACTICE AUTHORITY. The professional review commission shall have the authority to adopt rules, standards, guidelines, or judgments relating to the scope of practice of the profession regulated under this chapter in accordance with the provisions of chapter 18.-- RCW (sections 101 through 106 of this act).

NEW SECTION. Sec. 413. A new section is added to chapter 18.53 RCW to read as follows:

OPTOMETRY‑-APPLICATION OF SCOPE OF PRACTICE AUTHORITY. The professional review commission shall have the authority to adopt rules, standards, guidelines, or judgments relating to the scope of practice of the profession regulated under this chapter in accordance with the provisions of chapter 18.-- RCW (sections 101 through 106 of this act).

NEW SECTION. Sec. 414. A new section is added to chapter 18.54 RCW to read as follows:

OPTOMETRY BOARD‑-APPLICATION OF SCOPE OF PRACTICE AUTHORITY. The professional review commission shall have the authority to adopt rules, standards, guidelines, or judgments relating to the scope of practice of the profession regulated under this chapter in accordance with the provisions of chapter 18.-- RCW (sections 101 through 106 of this act).

NEW SECTION. Sec. 415. A new section is added to chapter 18.55 RCW to read as follows:

OCULARISTS‑-APPLICATION OF SCOPE OF PRACTICE AUTHORITY. The professional review commission shall have the authority to adopt rules, standards, guidelines, or judgments relating to the scope of practice of the profession regulated under this chapter in accordance with the provisions of chapter 18.-- RCW (sections 101 through 106 of this act).

NEW SECTION. Sec. 416. A new section is added to chapter 18.57 RCW to read as follows:

OSTEOPATHIC PHYSICIANS AND SURGEONS‑-APPLICATION OF SCOPE OF PRACTICE AUTHORITY. The professional review commission shall have the authority to adopt rules, standards, guidelines, or judgments relating to the scope of practice of the profession regulated under this chapter in accordance with the provisions of chapter 18.-- RCW (sections 101 through 106 of this act).

NEW SECTION. Sec. 417. A new section is added to chapter 18.57A RCW to read as follows:

OSTEOPATHIC PHYSICIANS AND SURGEONS' ASSISTANTS‑-APPLICATION OF SCOPE OF PRACTICE AUTHORITY. The professional review commission shall have the authority to adopt rules, standards, guidelines, or judgments relating to the scope of practice of the profession regulated under this chapter in accordance with the provisions of chapter 18.-- RCW (sections 101 through 106 of this act).

NEW SECTION. Sec. 418. A new section is added to chapter 18.59 RCW to read as follows:

OCCUPATIONAL THERAPY‑-APPLICATION OF SCOPE OF PRACTICE AUTHORITY. The professional review commission shall have the authority to adopt rules, standards, guidelines, or judgments relating to the scope of practice of the profession regulated under this chapter in accordance with the provisions of chapter 18.-- RCW (sections 101 through 106 of this act).

NEW SECTION. Sec. 419. A new section is added to chapter 18.64 RCW to read as follows:

PHARMACISTS‑-APPLICATION OF SCOPE OF PRACTICE AUTHORITY. The professional review commission shall have the authority to adopt rules, standards, guidelines, or judgments relating to the scope of practice of the profession regulated under this chapter in accordance with the provisions of chapter 18.-- RCW (sections 101 through 106 of this act).

NEW SECTION. Sec. 420. A new section is added to chapter 18.64A RCW to read as follows:

PHARMACY ASSISTANTS‑-APPLICATION OF SCOPE OF PRACTICE AUTHORITY. The professional review commission shall have the authority to adopt rules, standards, guidelines, or judgments relating to the scope of practice of the profession regulated under this chapter in accordance with the provisions of chapter 18.-- RCW (sections 101 through 106 of this act).

NEW SECTION. Sec. 421. A new section is added to chapter 18.71 RCW to read as follows:

PHYSICIANS‑-APPLICATION OF SCOPE OF PRACTICE AUTHORITY. The professional review commission shall have the authority to adopt rules, standards, guidelines, or judgments relating to the scope of practice of the profession regulated under this chapter in accordance with the provisions of chapter 18.-- RCW (sections 101 through 106 of this act).

NEW SECTION. Sec. 422. A new section is added to chapter 18.71A RCW to read as follows:

PHYSICIANS' ASSISTANTS‑-APPLICATION OF SCOPE OF PRACTICE AUTHORITY. The professional review commission shall have the authority to adopt rules, standards, guidelines, or judgments relating to the scope of practice of the profession regulated under this chapter in accordance with the provisions of chapter 18.-- RCW (sections 101 through 106 of this act).

NEW SECTION. Sec. 423. A new section is added to chapter 18.73 RCW to read as follows:

EMERGENCY MEDICAL SERVICES‑-APPLICATION OF SCOPE OF PRACTICE AUTHORITY. The professional review commission shall have the authority to adopt rules, standards, guidelines, or judgments relating to the scope of practice of the profession regulated under this chapter in accordance with the provisions of chapter 18.-- RCW (sections 101 through 106 of this act).

NEW SECTION. Sec. 424. A new section is added to chapter 18.74 RCW to read as follows:

PHYSICAL THERAPY‑-APPLICATION OF SCOPE OF PRACTICE AUTHORITY. The professional review commission shall have the authority to adopt rules, standards, guidelines, or judgments relating to the scope of practice of the profession regulated under this chapter in accordance with the provisions of chapter 18.-- RCW (sections 101 through 106 of this act).

NEW SECTION. Sec. 425. A new section is added to chapter 18.83 RCW to read as follows:

PSYCHOLOGISTS‑-APPLICATION OF SCOPE OF PRACTICE AUTHORITY. The professional review commission shall have the authority to adopt rules, standards, guidelines, or judgments relating to the scope of practice of the profession regulated under this chapter in accordance with the provisions of chapter 18.-- RCW (sections 101 through 106 of this act).

NEW SECTION. Sec. 426. A new section is added to chapter 18.84 RCW to read as follows:

RADIOLOGIC TECHNOLOGISTS‑-APPLICATION OF SCOPE OF PRACTICE AUTHORITY. The professional review commission shall have the authority to adopt rules, standards, guidelines, or judgments relating to the scope of practice of the profession regulated under this chapter in accordance with the provisions of chapter 18.-- RCW (sections 101 through 106 of this act).

NEW SECTION. Sec. 427. NURSES‑-APPLICATION OF SCOPE OF PRACTICE AUTHORITY. The professional review commission shall have the authority to adopt rules, standards, guidelines, or judgments relating to the scope of practice of the profession regulated under this chapter in accordance with the provisions of chapter 18.-- RCW (sections 101 through 106 of this act).

NEW SECTION. Sec. 428. A new section is added to chapter 18.88A RCW to read as follows:

NURSING ASSISTANTS‑-APPLICATION OF SCOPE OF PRACTICE AUTHORITY. The professional review commission shall have the authority to adopt rules, standards, guidelines, or judgments relating to the scope of practice of the profession regulated under this chapter in accordance with the provisions of chapter 18.-- RCW (sections 101 through 106 of this act).

NEW SECTION. Sec. 429. A new section is added to chapter 18.89 RCW to read as follows:

RESPIRATORY CARE PRACTITIONERS‑-APPLICATION OF SCOPE OF PRACTICE AUTHORITY. The professional review commission shall have the authority to adopt rules, standards, guidelines, or judgments relating to the scope of practice of the profession regulated under this chapter in accordance with the provisions of chapter 18.-- RCW (sections 101 through 106 of this act).

NEW SECTION. Sec. 430. A new section is added to chapter 18.92 RCW to read as follows:

VETERINARY‑-APPLICATION OF SCOPE OF PRACTICE AUTHORITY. The professional review commission shall have the authority to adopt rules, standards, guidelines, or judgments relating to the scope of practice of the profession regulated under this chapter in accordance with the provisions of chapter 18.-- RCW (sections 101 through 106 of this act).

NEW SECTION. Sec. 431. A new section is added to chapter 18.135 RCW to read as follows:

HEALTH CARE ASSISTANTS‑-APPLICATION OF SCOPE OF PRACTICE AUTHORITY. The professional review commission shall have the authority to adopt rules, standards, guidelines, or judgments relating to the scope of practice of the profession regulated under this chapter in accordance with the provisions of chapter 18.-- RCW (sections 101 through 106 of this act).

NEW SECTION. Sec. 432. A new section is added to chapter 18.155 RCW to read as follows:

SEX OFFENDER TREATMENT PROVIDER‑-APPLICATION OF SCOPE OF PRACTICE AUTHORITY. The professional review commission shall have the authority to adopt rules, standards, guidelines, or judgments relating to the scope of practice of the profession regulated under this chapter in accordance with the provisions of chapter 18.-- RCW (sections 101 through 106 of this act).

NEW SECTION. Sec. 433. A new section is added to chapter 18.138 RCW to read as follows:

DIETICIANS AND NUTRITIONISTS. The professional review commission shall have the authority to adopt rules, standards, guidelines, or judgments relating to the scope of practice of the profession regulated under this chapter in accordance with the provisions of chapter 18.-- RCW (sections 101 through 106 of this act).

NEW SECTION. Sec. 434. A new section is added to chapter 18.108 RCW to read as follows:

MASSAGE THERAPISTS. The professional review commission shall have the authority to adopt rules, standards, guidelines, or judgments relating to the scope of practice of the profession regulated under this chapter in accordance with the provisions of chapter 18.-- RCW (sections 101 through 106 of this act).

Sec. 435. 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.

NEW SECTION. Sec. 436. 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.

PART V - NURSING AND MENTAL HEALTH

NURSING CARE QUALITY ASSURANCE COMMISSION

NEW SECTION. Sec. 501. It is the purpose of the nursing care quality assurance commission to regulate the competency and quality of professional health care providers under its jurisdiction by establishing, monitoring, and enforcing qualifications for licensing, consistent standards of practice, continuing competency mechanisms, and discipline. Rules, policies, and procedures developed by the commission must promote the delivery of quality health care to the residents of the state of Washington.

NEW SECTION. Sec. 502. Unless a different meaning is plainly required by the context, the definitions set forth in this section apply throughout this chapter.

(1) "Commission" means the Washington state nursing care quality assurance commission.

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

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

(4) "Diagnosis," in the context of nursing practice, means the identification of, and discrimination between, the person's physical and psycho-social signs and symptoms that are essential to effective execution and management of the nursing care regimen.

(5) "Diploma" means written official verification of completion of an approved nursing education program.

(6) "Nurse" or "nursing," unless otherwise specified as a practical nurse or practical nursing, means a registered nurse or registered nursing.

NEW SECTION. Sec. 503. (1) It is unlawful for a person to practice or to offer to practice as a registered nurse in this state unless that person has been licensed under this chapter. A person who holds a license to practice as a registered nurse in this state may use the title "registered nurse" and the abbreviation "R.N." No other person may assume that title or use the abbreviation or any other words, letters, signs, or figures to indicate that the person using them is a registered nurse.

(2) It is unlawful for a person to practice or to offer to practice as an advanced registered nurse practitioner or as a nurse practitioner in this state unless that person has been licensed under this chapter. A person who holds a license to practice as an advanced registered nurse practitioner in this state may use the titles "advanced registered nurse practitioner" and "nurse practitioner" and the abbreviations "A.R.N.P." and "N.P." No other person may assume those titles or use those abbreviations or any other words, letters, signs, or figures to indicate that the person using them is an advanced registered nurse practitioner or nurse practitioner.

(3) It is unlawful for a person to practice or to offer to practice as a licensed practical nurse in this state unless that person has been licensed under this chapter. A person who holds a license to practice as a licensed practical nurse in this state may use the title "licensed practical nurse" and the abbreviation "L.P.N." No other person may assume that title or use that abbreviation or any other words, letters, signs, or figures to indicate that the person using them is a licensed practical nurse.

NEW SECTION. Sec. 504. (1) "Registered nursing practice" means the performance of acts requiring substantial specialized knowledge, judgment, and skill based on the principles of the biological, physiological, behavioral, and sociological sciences in either:

(a) The observation, assessment, diagnosis, care or counsel, and health teaching of the ill, injured, or infirm, or in the maintenance of health or prevention of illness of others;

(b) The performance of such additional acts requiring education and training and that are recognized by the commission to be performed by registered nurses licensed under this chapter and that are authorized by the commission through its rules;

(c) The administration, supervision, delegation, and evaluation of nursing practice. However, nothing in this subsection affects the authority of a hospital, hospital district, medical clinic, or office, concerning its administration and supervision;

(d) The teaching of nursing;

(e) The executing of medical regimen as prescribed by a licensed physician and surgeon, dentist, osteopathic physician and surgeon, podiatric physician and surgeon, physician assistant, osteopathic physician assistant, or advanced registered nurse practitioner.

(2) Nothing in this section prohibits a person from practicing a profession for which a license has been issued under the laws of this state or specifically authorized by any other law of the state of Washington.

(3) This section does not prohibit (a) the nursing care of the sick, without compensation, by an unlicensed person who does not hold himself or herself out to be a registered nurse, or (b) the practice of licensed practical nursing by a licensed practical nurse.

NEW SECTION. Sec. 505. "Advanced registered nursing practice" means the performance of the acts of a registered nurse and the performance of an expanded role in providing health care services, the scope of which is defined by rule by the commission. Upon approval by the commission, an advanced registered nurse practitioner may prescribe legend drugs and controlled substances contained in Schedule V of the Uniform Controlled Substances Act, chapter 69.50 RCW.

Nothing in this section prohibits a person from practicing a profession for which a license has been issued under the laws of this state or specifically authorized by any other law of the state of Washington.

This section does not prohibit (1) the nursing care of the sick, without compensation, by an unlicensed person who does not hold himself or herself out to be an advanced registered nurse practitioner, or (2) the practice of registered nursing by a licensed registered nurse or the practice of licensed practical nursing by a licensed practical nurse.

NEW SECTION. Sec. 506. "Licensed practical nursing practice" means the performance of services requiring the knowledge, skill, and judgment necessary for carrying out selected aspects of the designated nursing regimen under the direction and supervision of a licensed physician and surgeon, dentist, osteopathic physician and surgeon, physician assistant, osteopathic physician assistant, podiatric physician and surgeon, advanced registered nurse practitioner, or registered nurse.

This section does not prohibit the nursing care of the sick, without compensation, by an unlicensed person who does not hold himself or herself out to be a licensed practical nurse.

NEW SECTION. Sec. 507. (1) The state nursing care quality assurance commission is established, consisting of eleven members to be appointed by the governor to four-year terms. No person may serve as a member of the commission for more than two consecutive full terms.

(2) There must be three registered nurse members, two advanced registered nurse practitioner members, three licensed practical nurse members, two public members, and one nonvoting midwife member licensed under chapter 18.50 RCW, on the commission. Each member of the commission must be a citizen of the United States and a resident of this state.

(3) Registered nurse members of the commission must:

(a) Be licensed as registered nurses under this chapter; and

(b) Have had at least five years' experience in the active practice of nursing and have been engaged in that practice within two years of appointment.

(4) Advanced registered nurse practitioner members of the commission must:

(a) Be licensed as advanced registered nurse practitioners under this chapter; and

(b) Have had at least five years' experience in the active practice of advanced registered nursing and have been engaged in that practice within two years of appointment.

(5) Licensed practical nurse members of the commission must:

(a) Be licensed as licensed practical nurses under this chapter; and

(b) Have had at least five years' actual experience as a licensed practical nurse and have been engaged in practice as a practical nurse within two years of appointment.

(6) Public members of the commission may not be a member of any other health care licensing board or commission, or have a fiduciary obligation to a facility rendering health services regulated by the commission, or have a material or financial interest in the rendering of health services regulated by the commission.

(7) The nonvoting licensed midwife member of the commission must:

(a) Be licensed as a midwife under chapter 18.50 RCW; and

(b) Have had at least five years' actual experience as a licensed midwife and have been engaged in practice as a midwife within two years of appointment.

In appointing the initial members of the commission, it is the intent of the legislature that, to the extent possible, the governor appoint the existing members of the board of nursing and the board of practical nursing repealed under chapter . . ., Laws of 1994 (this act). The governor may appoint initial members of the commission to staggered terms of from one to four years. Thereafter, all members shall be appointed to full four-year terms. Members of the commission hold office until their successors are appointed.

NEW SECTION. Sec. 508. The governor may remove a member of the commission for neglect of duty, misconduct, malfeasance or misfeasance in office, or for incompetency or unprofessional conduct as defined in chapter 18.130 RCW. Whenever the governor is satisfied that a member of the commission has been guilty of neglect of duty, misconduct, malfeasance or misfeasance in office, or of incompetency or unprofessional conduct, the governor shall file with the secretary of state a statement of the causes for and the order of removal from office, and the secretary shall forthwith send a certified copy of the statement of causes and order of removal to the last known post office address of the member. If a vacancy occurs on the commission, the governor shall appoint a replacement member to fill the remainder of the unexpired term.

NEW SECTION. Sec. 509. Each commission member shall be compensated in accordance with RCW 43.03.240 and shall be paid travel expenses when away from home in accordance with RCW 43.03.050 and 43.03.060.

NEW SECTION. Sec. 510. The commission shall annually elect from its members a chairperson, a vice-chairperson, and a secretary. The commission shall meet at least quarterly at times and places it designates. It shall hold such other meetings during the year as may be deemed necessary to transact its business. A majority of the commission members appointed and serving constitutes a quorum at a meeting. All meetings of the commission must be open and public, except that the commission may hold executive sessions to the extent permitted by chapter 42.30 RCW.

Carrying a motion or resolution, adopting a rule, or passing a measure requires the affirmative vote of a majority of a quorum of the commission. The commission may appoint panels consisting of at least three members. A quorum for transaction of any business by a panel is a minimum of three members. A majority vote of a quorum of the panel is required to transact business delegated to it by the commission.

NEW SECTION. Sec. 511. The commission shall keep a record of all of its proceedings and make such reports to the governor as may be required. The commission may adopt rules or issue advisory opinions in response to questions put to it by professional health associations, licensed nurses, and consumers in this state concerning the authority of various categories of licensed nurses to perform particular acts. The commission shall define by rule the criteria for granting to advanced registered nurse practitioners the authority to prescribe legend drugs and Schedule V controlled substances.

The commission shall approve curricula and shall establish criteria for minimum standards for schools preparing persons for licensing as registered nurses, advanced registered nurse practitioners, and licensed practical nurses under this chapter. The commission shall approve such schools of nursing as meet the requirements of this chapter and the commission, and the commission shall approve establishment of basic nursing education programs and shall establish criteria as to the need for and the size of a program and the type of program and the geographical location. The commission shall establish criteria for proof of reasonable currency of knowledge and skill as a basis for safe practice after three years' inactive or lapsed status. The commission shall establish criteria for licensing by endorsement. The commission shall determine examination requirements for applicants for licensing as registered nurses, advanced registered nurse practitioners, and licensed practical nurses under this chapter, and shall certify to the secretary for licensing duly qualified applicants.

The commission shall adopt such rules under chapter 34.05 RCW as are necessary to fulfill the purposes of this chapter.

The commission is the successor in interest of the board of nursing and the board of practical nursing. All contracts, undertakings, agreements, rules, regulations, decisions, orders, and policies of the former board of nursing or the board of practical nursing continue in full force and effect under the commission until the commission amends or rescinds those rules, regulations, decisions, orders, or policies.

The members of the commission are immune from suit in an action, civil or criminal, based on its disciplinary proceedings or other official acts performed in good faith as members of the commission.

Whenever the workload of the commission requires, the commission may request that the secretary appoint pro tempore members of the commission. When serving, pro tempore members of the commission have all of the powers, duties, and immunities, and are entitled to all of the emoluments, including travel expenses, of regularly appointed members of the commission.

NEW SECTION. Sec. 512. The Uniform Disciplinary Act, chapter 18.130 RCW, governs unlicensed practice, the issuance and denial of licenses, and the discipline of licensees under this chapter.

NEW SECTION. Sec. 513. The secretary shall appoint, after consultation with the commission, an executive director who shall act to carry out this chapter. The secretary shall also employ such professional, secretarial, clerical, and other assistants as may be necessary to effectively administer this chapter. The secretary shall fix the compensation and provide for travel expenses for the executive director and all such employees, in accordance with RCW 43.03.050 and 43.03.060.

NEW SECTION. Sec. 514. The executive director must be a graduate of an approved nursing education program and of a college or university, with a masters' degree, and currently licensed as a registered nurse under this chapter; have a minimum of eight years' experience in nursing in any combination of administration and nursing education; and have been actively engaged in the practice of registered nursing or nursing education within two years immediately before the time of appointment.

NEW SECTION. Sec. 515. An institution desiring to conduct a school of registered nursing or a school or program of practical nursing, or both, shall apply to the commission and submit evidence satisfactory to the commission that:

(1) It is prepared to carry out the curriculum approved by the commission for basic registered nursing or practical nursing, or both; and

(2) It is prepared to meet other standards established by law and by the commission.

The commission shall make, or cause to be made, such surveys of the schools and programs, and of institutions and agencies to be used by the schools and programs, as it determines are necessary. If in the opinion of the commission, the requirements for an approved school of registered nursing or a school or program of practical nursing, or both, are met, the commission shall approve the school or program.

NEW SECTION. Sec. 516. (1) An applicant for a license to practice as a registered nurse shall submit to the commission:

(a) An attested written application on a department form;

(b) Written official evidence of a diploma from an approved school of nursing; and

(2) An applicant for a license to practice as an advanced registered nurse practitioner shall submit to the commission:

(a) An attested written application on a department form;

(b) Written official evidence of completion of an advanced registered nurse practitioner training program meeting criteria established by the commission; and

(3) An applicant for a license to practice as a licensed practical nurse shall submit to the commission:

(a) An attested written application on a department form;

(b) Written official evidence that the applicant is over the age of eighteen;

(d) Written official evidence of completion of an approved practical nursing program, or its equivalent; and

(e) Any other official records specified by the commission.

(4) At the time of submission of the application, the applicant for a license to practice as a registered nurse, advanced registered nurse practitioner, or licensed practical nurse must not be in violation of chapter 18.130 RCW or this chapter.

(5) The commission shall establish by rule the criteria for evaluating the education of all applicants.

NEW SECTION. Sec. 517. An applicant for a license to practice as a registered nurse, advanced registered nurse practitioner, or licensed practical nurse must pass an examination in subjects determined by the commission. The examination may be supplemented by an oral or practical examination. The commission shall establish by rule the requirements for applicants who have failed the examination to qualify for reexamination.

NEW SECTION. Sec. 518. When authorized by the commission, the department shall issue an interim permit authorizing the applicant to practice registered nursing, advanced registered nursing, or licensed practical nursing, as appropriate, from the time of verification of the completion of the school or training program until notification of the results of the examination. Upon the applicant passing the examination, and if all other requirements established by the commission for licensing are met, the department shall issue the applicant a license to practice registered nursing, advanced registered nursing, or licensed practical nursing, as appropriate. If the applicant fails the examination, the interim permit expires upon notification to the applicant, and is not renewable. The holder of an interim permit is subject to chapter 18.130 RCW.

NEW SECTION. Sec. 519. Upon approval of the application by the commission, the department shall issue a license by endorsement without examination to practice as a registered nurse or as a licensed practical nurse to a person who is licensed as a registered nurse or licensed practical nurse under the laws of another state, territory, or possession of the United States, and who meets all other qualifications for licensing.

An applicant who has graduated from a school or program of nursing outside the United States and is licensed as a registered nurse or licensed practical nurse, or their equivalents, outside the United States must meet all qualifications required by this chapter and pass examinations as determined by the commission.

NEW SECTION. Sec. 520. An applicant for a license to practice as a registered nurse, advanced registered nurse practitioner, or licensed practical nurse shall pay a fee as determined by the secretary under RCW 43.70.250 to the state treasurer.

NEW SECTION. Sec. 521. A license issued under this chapter, whether in an active or inactive status, must be renewed, except as provided in this chapter. The licensee shall send the renewal form to the department with a renewal fee, as determined by the secretary under RCW 43.70.250, before the expiration date. Upon receipt of the renewal form and the appropriate fee, the department shall issue the licensee a license, which declares the holder to be a legal practitioner of registered nursing, advanced registered nursing practice, or licensed practical nursing, as appropriate, in either active or inactive status, for the period of time stated on the license.

NEW SECTION. Sec. 522. A person licensed under this chapter who allows his or her license to lapse by failing to renew the license, shall on application for renewal pay a penalty determined by the secretary under RCW 43.70.250. If the licensee fails to renew the license before the end of the current licensing period, the department shall issue the license for the next licensing period upon receipt of a written application and fee determined by the secretary under RCW 43.70.250. Persons on lapsed status for three or more years must provide evidence of knowledge and skill of current practice as required by the commission.

NEW SECTION. Sec. 523. A person licensed under this chapter who desires to retire temporarily from registered nursing practice, advanced registered nursing practice, or licensed practical nursing practice in this state shall send a written notice to the secretary.

Upon receipt of the notice the department shall place the name of the person on inactive status. While remaining on this status the person shall not practice in this state any form of nursing provided for in this chapter. When the person desires to resume practice, the person shall apply to the commission for renewal of the license and pay a renewal fee to the state treasurer. Persons on inactive status for three years or more must provide evidence of knowledge and skill of current practice as required by the commission or as provided in this chapter.

NEW SECTION. Sec. 524. (1) For persons licensed as registered nurses or advanced registered nurse practitioners, this chapter shall not be construed as:

(a) Prohibiting the incidental care of the sick by domestic servants or persons primarily employed as housekeepers, so long as they do not practice registered nursing within the meaning of this chapter;

(b) Preventing a person from the domestic administration of family remedies or the furnishing of nursing assistance in case of emergency;

(c) Prohibiting the practice of nursing by students enrolled in approved schools as may be incidental to their course of study or prohibiting the students from working as nursing aides;

(d) Prohibiting auxiliary services provided by persons carrying out duties necessary for the support of nursing services, including those duties that involve minor nursing services for persons performed in hospitals, nursing homes, or elsewhere under the direction of licensed physicians or the supervision of licensed registered nurses;

(e) Prohibiting the practice of nursing in this state by a legally qualified nurse of another state or territory whose engagement requires him or her to accompany and care for a patient temporarily residing in this state during the period of one such engagement, not to exceed six months in length, if the person does not represent or hold himself or herself out as a registered nurse licensed to practice in this state;

(f) Prohibiting nursing or care of the sick, with or without compensation, when done in connection with the practice of the religious tenets of a church by adherents of the church so long as they do not engage in the practice of nursing as defined in this chapter;

(g) Prohibiting the practice of a legally qualified nurse of another state who is employed by the United States government or a bureau, division, or agency thereof, while in the discharge of his or her official duties;

(h) Permitting the measurement of the powers or range of human vision, or the determination of the accommodation and refractive state of the human eye or the scope of its functions in general, or the fitting or adaptation of lenses for the aid thereof;

(i) Permitting the prescribing or directing the use of, or using, an optical device in connection with ocular exercises, visual training, vision training, or orthoptics;

(j) Permitting the prescribing of contact lenses for, or the fitting and adaptation of contact lenses to, the human eye;

(k) Prohibiting the performance of routine visual screening;

(l) Permitting the practice of dentistry or dental hygiene as defined in chapters 18.32 and 18.29 RCW, respectively;

(m) Permitting the practice of chiropractic as defined in chapter 18.25 RCW including the adjustment or manipulation of the articulation of the spine;

(n) Permitting the practice of podiatric medicine and surgery as defined in chapter 18.22 RCW;

(o) Permitting the performance of major surgery, except such minor surgery as the commission may have specifically authorized by rule adopted in accordance with chapter 34.05 RCW;

(p) Permitting the prescribing of controlled substances as defined in Schedules I through IV of the Uniform Controlled Substances Act, chapter 69.50 RCW, except as provided in (r) of this subsection;

(q) Prohibiting the determination and pronouncement of death;

(r) Prohibiting advanced registered nurse practitioners, approved by the commission as certified registered nurse anesthetists from selecting, ordering, or administering controlled substances as defined in Schedules II through IV of the Uniform Controlled Substances Act, chapter 69.50 RCW, consistent with their commission-recognized scope of practice; subject to facility-specific protocols, and subject to a request for certified registered nurse anesthetist anesthesia services issued by a physician licensed under chapter 18.71 RCW, an osteopathic physician and surgeon licensed under chapter 18.57 RCW, a dentist licensed under chapter 18.32 RCW, or a podiatric physician and surgeon licensed under chapter 18.22 RCW; the authority to select, order, or administer Schedule II through IV controlled substances being limited to those drugs that are to be directly administered to patients who require anesthesia for diagnostic, operative, obstetrical, or therapeutic procedures in a hospital, clinic, ambulatory surgical facility, or the office of a practitioner licensed under chapter 18.71, 18.57, or 18.32 RCW; "select" meaning the decision-making process of choosing a drug, dosage, route, and time of administration; and "order" meaning the process of directing licensed individuals pursuant to their statutory authority to directly administer a drug or to dispense, deliver, or distribute a drug for the purpose of direct administration to a patient, under instructions of the certified registered nurse anesthetist. "Protocol" means a statement regarding practice and documentation concerning such items as categories of patients, categories of medications, or categories of procedures rather than detailed case-specific formulas for the practice of nurse anesthesia.

(2) For persons licensed as licensed practical nurses, this chapter shall not be construed as:

(a) Prohibiting the incidental care of the sick by domestic servants or persons primarily employed as housekeepers, so long as they do not practice practical nursing within the meaning of this chapter;

(b) Preventing a person from the domestic administration of family remedies or the furnishing of nursing assistance in case of emergency;

(c) Prohibiting the practice of practical nursing by students enrolled in approved schools as may be incidental to their course of study or prohibiting the students from working as nursing assistants;

(e) Prohibiting or preventing the practice of nursing in this state by a legally qualified nurse of another state or territory whose engagement requires him or her to accompany and care for a patient temporarily residing in this state during the period of one such engagement, not to exceed six months in length, if the person does not represent or hold himself or herself out as a licensed practical nurse licensed to practice in this state;

(f) Prohibiting nursing or care of the sick, with or without compensation, when done in connection with the practice of the religious tenets of a church by adherents of the church so long as they do not engage in licensed practical nurse practice as defined in this chapter;

(g) Prohibiting the practice of a legally qualified nurse of another state who is employed by the United States government or any bureau, division, or agency thereof, while in the discharge of his or her official duties.

NEW SECTION. Sec. 525. An advanced registered nurse practitioner under his or her license may perform for compensation nursing care, as that term is usually understood, of the ill, injured, or infirm, and in the course thereof, she or he may do the following things that shall not be done by a person not so licensed, except as provided in sections 526 and 527 of this act:

(1) Perform specialized and advanced levels of nursing as defined by the commission;

(2) Prescribe legend drugs and Schedule V controlled substances, as defined in the Uniform Controlled Substances Act, chapter 69.50 RCW, within the scope of practice defined by the commission;

(3) Perform all acts provided in section 526 of this act;

(4) Hold herself or himself out to the public or designate herself or himself as an advanced registered nurse practitioner or as a nurse practitioner.

NEW SECTION. Sec. 526. A registered nurse under his or her license may perform for compensation nursing care, as that term is usually understood, of the ill, injured, or infirm, and in the course thereof, she or he may do the following things that shall not be done by a person not so licensed, except as provided in section 527 of this act:

(1) At or under the general direction of a licensed physician and surgeon, dentist, osteopathic physician and surgeon, podiatric physician and surgeon, physician assistant, osteopathic physician assistant, or advanced registered nurse practitioner acting within the scope of his or her license, administer medications, treatments, tests, and inoculations, whether or not the severing or penetrating of tissues is involved and whether or not a degree of independent judgment and skill is required;

(2) Delegate to other persons engaged in nursing, the functions outlined in subsection (1) of this section;

(3) Instruct nurses in technical subjects pertaining to nursing;

(4) Hold herself or himself out to the public or designate herself or himself as a registered nurse.

NEW SECTION. Sec. 527. A licensed practical nurse under his or her license may perform nursing care, as that term is usually understood, of the ill, injured, or infirm, and in the course thereof may, under the direction of a licensed physician and surgeon, osteopathic physician and surgeon, dentist, podiatric physician and surgeon, physician assistant, osteopathic physician assistant, advanced registered nurse practitioner acting under the scope of his or her license, or at the direction and under the supervision of a registered nurse, administer drugs, medications, treatments, tests, injections, and inoculations, whether or not the piercing of tissues is involved and whether or not a degree of independent judgment and skill is required, when selected to do so by one of the licensed practitioners designated in this section, or by a registered nurse who need not be physically present; if the order given is reduced to writing within a reasonable time and made a part of the patient's record.

NEW SECTION. Sec. 528. It is not a violation of chapter 18.71 or 18.57 RCW for a registered nurse, at or under the general direction of a licensed physician and surgeon, or osteopathic physician and surgeon, to administer prescribed drugs, injections, inoculations, tests, or treatment whether or not the piercing of tissues is involved.

NEW SECTION. Sec. 529. (1) In accordance with rules adopted by the commission, public school districts and private schools that offer classes for any of grades kindergarten through twelve may provide for clean, intermittent bladder catheterization of students or assisted self-catheterization of students who are in the custody of the school district or private school at the time. After consultation with staff of the superintendent of public instruction, the commission shall adopt rules in accordance with chapter 34.05 RCW, that provide for the following and such other matters as the commission deems necessary to the proper implementation of this section:

(a) A requirement for a written, current, and unexpired request from a parent, legal guardian, or other person having legal control over the student that the school district or private school provide for the catheterization of the student;

(b) A requirement for a written, current, and unexpired request from a physician licensed under chapter 18.71 or 18.57 RCW that catheterization of the student be provided for during the hours when school is in session or the hours when the student is under the supervision of school officials;

(c) A requirement for written, current, and unexpired instructions from an advanced registered nurse practitioner or a registered nurse licensed under this chapter regarding catheterization that include (i) a designation of the school district or private school employee or employees who may provide for the catheterization, and (ii) a description of the nature and extent of any required supervision; and

(d) The nature and extent of acceptable training that shall (i) be provided by a physician, advanced registered nurse practitioner, or registered nurse licensed under chapter 18.71 or 18.57 RCW, or this chapter, and (ii) be required of school district or private school employees who provide for the catheterization of a student under this section, except that a licensed practical nurse licensed under this chapter is exempt from training.

(2) This section does not require school districts to provide intermittent bladder catheterization of students.

NEW SECTION. Sec. 530. The department, subject to chapter 34.05 RCW, the Washington Administrative Procedure Act, may adopt such reasonable rules as may be necessary to carry out the duties imposed upon it in the administration of this chapter.

NEW SECTION. Sec. 531. As of the effective date of this act, all rules, regulations, decisions, and orders of the board of nursing under chapter 18.88 RCW or the board of practical nursing under chapter 18.78 RCW continue to be in effect under the commission, until the commission acts to modify the rules, regulations, decisions, or orders.

NEW SECTION. Sec. 532. Sections 427 and 501 through 531 of this act constitute a new chapter in Title 18 RCW.

NEW SECTION. Sec. 533. The following acts or parts of acts are each repealed:

(1) RCW 18.78.005 and 1991 c 84 s 1 & 1983 c 55 s 1;

(2) RCW 18.78.010 and 1991 c 84 s 13, 1991 c 3 s 185, 1983 c 55 s 2, 1967 c 79 s 1, 1963 c 15 s 1, & 1949 c 222 s 1;

(3) RCW 18.78.020 and 1991 c 84 s 2, 1983 c 55 s 3, 1967 c 79 s 2, & 1949 c 222 s 2;

(4) RCW 18.78.030 and 1991 c 84 s 3, 1983 c 55 s 4, & 1949 c 222 s 3;

(5) RCW 18.78.040 and 1991 c 84 s 4, 1984 c 287 s 47, 1983 c 55 s 5, 1975-'76 2nd ex.s. c 34 s 45, 1967 c 188 s 4, & 1949 c 222 s 4;

(6) RCW 18.78.050 and 1991 c 84 s 5, 1988 c 211 s 4, 1986 c 259 s 129, 1983 c 55 s 6, 1979 c 158 s 64, 1967 c 79 s 3, & 1949 c 222 s 5;

(7) RCW 18.78.054 and 1987 c 150 s 49 & 1986 c 259 s 128;

(8) RCW 18.78.055 and 1991 c 84 s 6 & 1983 c 55 s 7;

(9) RCW 18.78.058 and 1987 c 150 s 50;

(10) RCW 18.78.060 and 1991 c 84 s 7, 1988 c 212 s 1, 1983 c 55 s 8, 1971 ex.s. c 292 s 26, 1963 c 15 s 2, & 1949 c 222 s 6;

(11) RCW 18.78.070 and 1986 c 259 s 130, 1983 c 55 s 9, & 1949 c 222 s 7;

(12) RCW 18.78.072 and 1988 c 211 s 3;

(13) RCW 18.78.080 and 1991 c 84 s 8, 1985 c 7 s 65, 1979 c 158 s 65, 1975 1st ex.s. c 30 s 68, 1963 c 15 s 3, & 1949 c 222 s 9;

(14) RCW 18.78.090 and 1991 c 84 s 9, 1986 c 259 s 131, 1985 c 7 s 66, 1983 c 55 s 10, 1979 c 158 s 66, 1975 1st ex.s. c 30 s 69, 1971 ex.s. c 266 s 14, 1967 c 79 s 4, 1963 c 15 s 4, & 1949 c 222 s 10;

(15) RCW 18.78.100 and 1991 c 84 s 10, 1991 c 3 s 190, 1983 c 55 s 11, 1971 c 68 s 1, & 1949 c 222 s 11;

(16) RCW 18.78.160 and 1991 c 84 s 12, 1983 c 55 s 15, & 1949 c 222 s 17;

(17) RCW 18.78.182 and 1991 c 84 s 11, 1983 c 55 s 19, 1971 c 68 s 2, & 1967 c 79 s 6;

(18) RCW 18.78.225 and 1991 c 3 s 192 & 1988 c 211 s 12;

(19) RCW 18.78.900 and 1949 c 222 s 19;

(20) RCW 18.78.901 and 1983 c 55 s 22;

(21) RCW 18.88.010 and 1973 c 133 s 1 & 1949 c 202 s 1;

(22) RCW 18.88.020 and 1973 c 133 s 2 & 1949 c 202 s 2;

(23) RCW 18.88.030 and 1991 c 3 s 213, 1989 c 114 s 1, 1979 c 158 s 69, 1973 c 133 s 3, 1961 c 288 s 1, & 1949 c 202 s 4;

(24) RCW 18.88.050 and 1989 c 114 s 2, 1973 c 133 s 4, & 1949 c 202 s 5;

(25) RCW 18.88.060 and 1973 c 133 s 5, 1961 c 288 s 3, & 1949 c 202 s 6;

(26) RCW 18.88.070 and 1989 c 114 s 3, 1973 c 133 s 6, & 1949 c 202 s 7;

(27) RCW 18.88.080 and 1991 c 3 s 214, 1988 c 211 s 8, 1984 c 287 s 50, 1977 c 75 s 12, 1975-'76 2nd ex.s. c 34 s 50, 1973 c 133 s 7, 1961 c 288 s 4, & 1949 c 202 s 8;

(28) RCW 18.88.086 and 1987 c 150 s 57 & 1986 c 259 s 135;

(29) RCW 18.88.090 and 1991 c 3 s 215, 1975-'76 2nd ex.s. c 34 s 51, 1973 c 133 s 8, 1961 c 288 s 5, & 1949 c 202 s 9;

(30) RCW 18.88.100 and 1973 c 133 s 9, 1961 c 288 s 6, & 1949 c 202 s 10;

(31) RCW 18.88.110 and 1973 c 133 s 10 & 1949 c 202 s 11;

(32) RCW 18.88.120 and 1973 c 133 s 11 & 1949 c 202 s 12;

(33) RCW 18.88.130 and 1989 c 114 s 4, 1973 c 133 s 12, 1961 s 288 s 7, & 1949 c 202 s 13;

(34) RCW 18.88.140 and 1989 c 114 s 5, 1973 c 133 s 13, 1961 c 288 s 8, & 1949 c 202 s 14;

(35) RCW 18.88.150 and 1989 c 114 s 6, 1988 c 211 s 5, 1973 c 133 s 14, 1961 c 288 s 9, & 1949 c 202 s 15;

(36) RCW 18.88.160 and 1991 c 3 s 216, 1985 c 7 s 68, 1975 1st ex.s. c 30 s 77, 1973 c 133 s 15, 1961 c 288 s 10, & 1949 c 202 s 16;

(37) RCW 18.88.170 and 1973 c 133 s 16 & 1949 c 202 s 17;

(38) RCW 18.88.175 and 1991 c 3 s 217 & 1988 c 211 s 13;

(39) RCW 18.88.190 and 1991 c 3 s 218, 1988 c 211 s 9, 1985 c 7 s 69, 1979 ex.s. c 106 s 1, 1975 1st ex.s. c 30 s 78, 1973 c 133 s 18, 1971 ex.s. c 266 s 18, 1961 c 288 s 11, & 1949 c 202 s 19;

(40) RCW 18.88.200 and 1991 c 3 s 219, 1988 c 211 s 10, 1985 c 7 s 70, 1975 1st ex.s. c 30 s 79, 1973 c 133 s 19, 1961 c 288 s 12, & 1949 c 202 s 20;

(41) RCW 18.88.220 and 1991 c 3 s 220, 1988 c 211 s 11, 1973 c 133 s 20, & 1949 c 202 s 22;

(42) RCW 18.88.270 and 1986 c 259 s 136, 1973 c 133 s 26, & 1949 c 202 s 27;

(43) RCW 18.88.280 and 1993 c 225 s 1, 1989 c 114 s 7, 1988 c 37 s 1, 1973 c 133 s 27, 1961 c 288 s 13, & 1949 c 202 s 28;

(44) RCW 18.88.285 and 1989 c 114 s 8, 1973 c 133 s 28, 1967 c 79 s 9, & 1961 c 288 s 14;

(45) RCW 18.88.290 and 1955 c 62 s 1;

(46) RCW 18.88.295 and 1988 c 48 s 1;

(47) RCW 18.88.300 and 1973 c 133 s 29;

(48) RCW 18.88.900 and 1949 c 202 s 29; and

(49) RCW 18.88A.070 and 1991 c 16 s 9, 1991 c 3 s 223, 1989 c 300 s 9, & 1988 c 267 s 9.

MENTAL HEALTH QUALITY ASSURANCE COUNCIL

Sec. 534. RCW 18.19.070 and 1991 c 3 s 22 are each amended to read as follows:

(1) ((Within sixty days of July 26, 1987, the secretary shall have authority to appoint advisory committees to further the purposes of this chapter. Each such committee shall be composed of five members, one member initially appointed for a term of one year, two for terms of two years, and two for terms of three years. No person may serve as a member of the committee for more than two consecutive terms.)) The Washington state mental health quality assurance council is created, consisting of nine members appointed by the secretary. All appointments shall be for a term of four years. No person may serve as a member of the council for more than two consecutive full terms.

Voting members of the council must include one social worker certified under RCW 18.19.110, one mental health counselor certified under RCW 18.19.120, one marriage and family therapist certified under RCW 18.19.130, one counselor registered under RCW 18.19.090, one hypnotherapist registered under RCW 18.19.090, and two public members. Nonvoting members of the council must include one psychiatrist licensed under chapter 18.71 RCW and one psychologist licensed under chapter 18.83 RCW. Each member of the council must be a citizen of the United States and a resident of this state. Public members of the council may not be a member of any other health care licensing board or commission, or have a fiduciary obligation to a facility rendering health services regulated by the council, or have a material or financial interest in the rendering of health services regulated by the council.

The secretary may appoint the initial members of the council to staggered terms of from one to four years. Thereafter, all members shall be appointed to full four-year terms. Members of the council hold office until their successors are appointed.

The secretary may remove any member of the ((~~advisory committees~~)) council for cause as specified by rule. In the case of a vacancy, the secretary shall appoint a person to serve for the remainder of the unexpired term.

(2) The ((~~advisory committees~~)) council shall ((~~each~~)) meet at the times and places designated by the secretary and shall hold meetings during the year as necessary to provide advice to the secretary.

Each member of ((~~an advisory committee~~)) the council shall be reimbursed for travel expenses as authorized in RCW 43.03.050 and 43.03.060. In addition, members of the ((~~committees~~)) council shall be compensated in accordance with RCW 43.03.240 when engaged in the authorized business of ((~~their committee.~~

(3) Members of an advisory committee shall be residents of this state. Each committee shall be composed of four individuals registered or certified in the category designated by the committee title, and one member who is a member of the public)) the council. The members of the council are immune from suit in an action, civil or criminal, based on their official acts performed in good faith as members of the council.

PART VI - MEDICAL, CHIROPRACTIC, AND DENTAL

MEDICAL QUALITY ASSURANCE COMMISSION

NEW SECTION. Sec. 601. A new section is added to chapter 18.71 RCW to read as follows:

It is the purpose of the medical quality assurance commission to regulate the competency and quality of professional health care providers under its jurisdiction by establishing, monitoring, and enforcing qualifications for licensing, consistent standards of practice, continuing competency mechanisms, and discipline. Rules, policies, and procedures developed by the commission must promote the delivery of quality health care to the residents of the state of Washington.

Sec. 602. 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~~)) "Commission" means the Washington state medical quality assurance commission.

(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. 603. RCW 18.71.015 and 1991 c 44 s 1 and 1991 c 3 s 159 are each reenacted and amended to read as follows:

((There is hereby created a board of medical examiners consisting of six individuals licensed to practice medicine in the state of Washington, one individual who is licensed as a physician assistant under chapter 18.71A RCW, and two individuals who are not physicians, to be known as the Washington state board of medical examiners.)) The Washington state medical quality assurance commission is established, consisting of thirteen individuals licensed to practice medicine in the state of Washington under this chapter, two individuals who are licensed as physician assistants under chapter 18.71A RCW, and four individuals who are members of the public. Each congressional district now existing or hereafter created in the state must be represented by at least one physician member of the commission. The terms of office of members of the commission are not affected by changes in congressional district boundaries. Public members of the commission may not be a member of any other health care licensing board or commission, or have a fiduciary obligation to a facility rendering health services regulated by the commission, or have a material or financial interest in the rendering of health services regulated by the commission.

The ((~~board~~)) members of the commission shall be appointed by the governor. ((~~On expiration of the term of any member, the governor shall appoint for a period of five years an individual of similar qualifications to take the place of such member.~~)) Members of the initial commission may be appointed to staggered terms of one to four years, 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. In appointing the initial members of the commission, it is the intent of the legislature that, to the extent possible, the existing members of the board of medical examiners and medical disciplinary board repealed under section 636, chapter . . ., Laws of 1994 (this act) be appointed to the commission. No member may serve more than two consecutive full terms. Each member shall hold office until ((~~the expiration of the term for which such member is appointed or until~~)) a successor ((~~shall have been~~)) is appointed ((~~and shall have qualified~~)).

Each member of the ((~~board shall~~)) commission must be a citizen of the United States, must be an actual resident of this state, and, if a physician, must have been licensed to practice medicine in this state for at least five years.

The ((~~board~~)) commission shall meet as soon as practicable after appointment and elect a chair ((~~and~~)), a vice-chair, and a secretary from its members. Meetings shall be held at least four times a year and at such place as the ((~~board shall~~)) commission determines and at such other times and places as the ((~~board~~)) commission deems necessary. A majority of the ((~~board~~)) commission members appointed and serving ((~~shall~~)) constitutes a quorum for the transaction of ((~~board~~)) commission business.

((~~It shall require~~)) The affirmative vote of a majority of a quorum of the ((~~board~~)) commission is required to carry any motion or resolution, to adopt any rule, or to pass any measure. The commission may appoint panels consisting of at least three members. A quorum for the transaction of any business by a panel is a minimum of three members. A majority vote of ((~~the members appointed to a panel of the board shall constitute~~)) a quorum ((~~for~~)) of the panel is required to transact business delegated to it by the ((~~board~~)) commission.

Each member of the ((~~board~~)) commission shall be compensated in accordance with RCW 43.03.240 and in addition thereto shall be reimbursed for travel expenses incurred in carrying out the duties of the ((~~board~~)) commission in accordance with RCW 43.03.050 and 43.03.060. Any such expenses shall be paid from funds appropriated to the department of health.

((~~Any member of the board may be removed by the governor for~~)) Whenever the governor is satisfied that a member of a commission has been guilty of neglect of duty, misconduct, or malfeasance or misfeasance in office, the governor shall file with the secretary of state a statement of the causes for and the order of removal from office, and the secretary shall forthwith send a certified copy of the statement of causes and order of removal to the last known post office address of the member.

Vacancies in the membership of the ((~~board~~)) commission shall be filled for the unexpired term by appointment by the governor.

The members of the commission are immune from suit in an action, civil or criminal, based on its disciplinary proceedings or other official acts performed in good faith as members of the commission.

Sec. 604. RCW 18.71.017 and 1961 c 284 s 11 are each amended to read as follows:

The board may ((~~make~~)) adopt such rules ((~~and regulations~~)) as are not inconsistent with the laws of this state as may be determined necessary or proper to carry out the purposes of this chapter. The commission is the successor in interest of the board of medical examiners and the medical disciplinary board. All contracts, undertakings, agreements, rules, regulations, and policies continue in full force and effect on the effective date of this act, unless otherwise repealed or rejected by this chapter or by the commission.

Sec. 605. 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 discipline of licensees under this chapter.

Sec. 606. 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~~)) commission, 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~~)) commission, 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~~)) commission, 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~~)) commission has 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~~)) this chapter 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~~)) 18.--.--- (section 529 of this act) and 28A.210.280.

Sec. 607. RCW 18.71.050 and 1991 c 3 s 161 are each amended to read as follows:

(1) Each applicant who has graduated from a school of medicine located in any state, territory, or possession of the United States, the District of Columbia, or the Dominion of Canada, shall file an application for licensure with the ((~~board~~)) commission on a form prepared by the secretary with the approval of the ((~~board~~)) commission. Each applicant shall furnish proof satisfactory to the ((~~board~~)) commission of the following:

(a) That the applicant has attended and graduated from a school of medicine approved by the ((~~board~~)) commission;

(b) That the applicant has completed two years of postgraduate medical training in a program acceptable to the ((~~board~~)) commission, provided that applicants graduating before July 28, 1985, may complete only one year of postgraduate medical training;

(d) That the applicant is physically and mentally capable of safely carrying on the practice of medicine. The ((~~board~~)) commission may require any applicant to submit to such examination or examinations as it deems necessary to determine an applicant's physical and/or mental capability to safely practice medicine.

(2) Nothing in this section shall be construed as prohibiting the ((~~board~~)) commission from requiring such additional information from applicants as it deems necessary. The issuance and denial of licenses are subject to chapter 18.130 RCW, the Uniform Disciplinary Act.

Sec. 608. RCW 18.71.051 and 1991 c 3 s 162 are each amended to read as follows:

Applicants for licensure to practice medicine who have graduated from a school of medicine located outside of the states, territories, and possessions of the United States, the District of Columbia, or the Dominion of Canada, shall file an application for licensure with the ((~~board~~)) commission on a form prepared by the secretary with the approval of the ((~~board~~)) commission. Each applicant shall furnish proof satisfactory to the ((~~board~~)) commission of the following:

(1) That he or she has completed in a school of medicine a resident course of professional instruction equivalent to that required in this chapter for applicants generally;

(2) That he or she meets all the requirements which must be met by graduates of the United States and Canadian school of medicine except that he or she need not have graduated from a school of medicine approved by the ((~~board~~)) commission;

(3) That he or she has satisfactorily passed the examination given by the educational council for foreign medical graduates or has met the requirements in lieu thereof as set forth in rules ((~~and regulations~~)) adopted by the ((~~board~~)) commission;

(4) That he or she has the ability to read, write, speak, understand, and be understood in the English language.

Sec. 609. RCW 18.71.055 and 1975 1st ex.s. c 171 s 8 are each amended to read as follows:

The ((~~board~~)) commission may approve any school of medicine which is located in any state, territory, or possession of the United States, the District of Columbia, or in the Dominion of Canada, provided that it:

(1) Requires collegiate instruction which includes courses deemed by the ((~~board~~)) commission to be prerequisites to medical education;

(2) Provides adequate instruction in the following subjects: Anatomy, biochemistry, microbiology and immunology, pathology, pharmacology, physiology, anaesthesiology, dermatology, gynecology, internal medicine, neurology, obstetrics, ((~~opthalmology~~)) ophthalmology, orthopedic surgery, otolaryngology, pediatrics, physical medicine and rehabilitation, preventive medicine and public health, psychiatry, radiology, surgery, and urology, and such other subjects determined by the ((~~board~~)) commission;

(3) Provides clinical instruction in hospital wards and out-patient clinics under guidance.

Approval may be withdrawn by the ((~~board~~)) commission at any time a medical school ceases to comply with one or more of the requirements of this section.

(4) Nothing in this section shall be construed to authorize the ((~~board~~)) commission to approve a school of osteopathy, osteopathy and surgery, or osteopathic medicine, for purposes of qualifying an applicant to be licensed under this chapter by direct licensure, reciprocity, or otherwise.

Sec. 610. RCW 18.71.060 and 1975 1st ex.s. c 171 s 9 are each amended to read as follows:

((~~Said board~~)) The commission shall keep an official record of all its proceedings, a part of which record shall consist of a register of all applicants for licensure under this chapter, with the result of each application. ((~~Said~~)) The record shall be evidence of all the proceedings of ((~~said board which~~)) the commission that are set forth ((~~therein~~)) in it.

Sec. 611. RCW 18.71.070 and 1985 c 322 s 3 are each amended to read as follows:

With the exception of those applicants granted licensure through the provisions of RCW 18.71.090 or 18.71.095, applicants for licensure must successfully complete an examination administered by the ((~~board~~)) commission to determine their professional qualifications. The ((~~board~~)) commission shall prepare and give, or approve the preparation and giving of, an examination which shall cover those general subjects and topics, a knowledge of which is commonly and generally required of candidates for the degree of doctor of medicine conferred by approved colleges or schools of medicine in the United States. Notwithstanding any other provision of law, the ((~~board shall have~~)) commission has the sole responsibility for determining the proficiency of applicants under this chapter, and, in so doing, may waive any prerequisite to licensure not set forth in this chapter.

The ((~~board~~)) commission may by rule establish the passing grade for the examination.

Examination results shall be part of the records of the ((~~board~~)) commission and shall be permanently kept with the applicant's file.

Sec. 612. RCW 18.71.080 and 1991 c 195 s 1 and 1991 c 3 s 163 are each reenacted and amended to read as follows:

Every person licensed to practice medicine in this state shall register with the secretary of health annually, and pay an annual renewal registration fee determined by the secretary as provided in RCW 43.70.250. The ((~~board~~)) commission may establish rules governing mandatory continuing education requirements which shall be met by physicians applying for renewal of licenses. The rules ((~~and regulations~~)) shall provide that mandatory continuing education requirements may be met in part by physicians showing evidence of the completion of approved activities relating to professional liability risk management. Any failure to register and pay the annual renewal registration fee shall render the license invalid, but such license shall be reinstated upon written application therefor to the secretary, and payment to the state of a penalty fee determined by the secretary as provided in RCW 43.70.250, together with all delinquent annual license renewal fees: PROVIDED, HOWEVER, That any person who fails to renew the license for a period of three years, shall in no event be entitled to renew the license under this section. Such a person in order to obtain a license to practice medicine in this state, shall file an original application as provided for in this chapter, along with the requisite fee therefor. The ((~~board~~)) commission, in its sole discretion, may permit such applicant to be licensed without examination if it is satisfied that such applicant meets all the requirements for licensure in this state, and is competent to engage in the practice of medicine.

Sec. 613. RCW 18.71.085 and 1991 c 44 s 2 are each amended to read as follows:

The ((~~board~~)) commission may adopt rules pursuant to this section authorizing an inactive license status.

(1) An individual licensed pursuant to chapter 18.71 RCW may place his or her license on inactive status. The holder of an inactive license shall not practice medicine and surgery in this state without first activating the license.

(2) The inactive renewal fee shall be established by the secretary pursuant to RCW 43.70.250. Failure to renew an inactive license shall result in cancellation in the same manner as an active license.

(3) An inactive license may be placed in an active status upon compliance with rules established by the ((~~board~~)) commission.

(4) Provisions relating to disciplinary action against a person with a license shall be applicable to a person with an inactive license, except that when disciplinary proceedings against a person with an inactive license have been initiated, the license shall remain inactive until the proceedings have been completed.

Sec. 614. RCW 18.71.090 and 1985 c 322 s 5 are each amended to read as follows:

Any applicant who meets the requirements of RCW 18.71.050 and has been licensed under the laws of another state, territory, or possession of the United States, or of any province of Canada, or an applicant who has satisfactorily passed examinations given by the national board of medical examiners may, in the discretion of the ((~~board~~)) commission, be granted a license without examination on the payment of the fees required by this chapter: PROVIDED, That the applicant must file with the ((~~board~~)) commission a copy of the license certified by the proper authorities of the issuing state to be a full, true copy thereof, and must show that the standards, eligibility requirements, and examinations of that state are at least equal in all respects to those of this state.

Sec. 615. RCW 18.71.095 and 1991 c 3 s 164 are each amended to read as follows:

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

(1) The ((~~board~~)) commission 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~~)) commission 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~~)) commission, the ((~~board~~)) commission 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~~)) commission 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~~)) commission 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~~)) commission 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~~)) commission to the same extent as other members of the medical profession, in accordance with this chapter and 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. 616. 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~~)) commission, 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. 617. 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~~)) commission upon a finding by the ((~~board~~)) commission 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 chapters 18.72 and~~)) under this chapter and chapter 18.130 RCW.

Sec. 618. RCW 18.71A.010 and 1990 c 196 s 1 are each amended to read as follows:

The definitions set forth in this section apply throughout this chapter.

(1) "Physician assistant" means a person who is licensed by the ((~~board~~)) commission 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~~)) Commission" means the ((~~board of medical examiners~~)) medical quality assurance commission.

(3) "Practice medicine" ((~~shall have~~)) has 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. 619. RCW 18.71A.020 and 1993 c 28 s 5 are each amended to read as follows:

(1) The ((~~board~~)) commission shall adopt rules fixing the qualifications and the educational and training requirements for licensure as a physician assistant or for those enrolled in any physician assistant training program. The requirements shall include completion of an accredited physician assistant training program approved by the ((~~board~~)) commission and eligibility to take an examination approved by the ((~~board, provided such~~)) commission, if the examination tests subjects substantially equivalent to the curriculum of an accredited physician assistant training program. Physician assistants licensed by the board of medical examiners as of June 7, 1990, shall continue to be licensed.

(2)(a) The ((~~board~~)) commission shall adopt rules governing the extent to which:

(i) Physician assistant students may practice medicine during training; and

(ii) Physician assistants may practice after successful completion of a physician assistant training course.

(b) Such rules shall provide:

(i) That the practice of a physician assistant shall be limited to the performance of those services for which he or she is trained; and

(ii) That each physician assistant 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 or physicians at the place where services are rendered.

(3) Applicants for licensure shall file an application with the ((~~board~~)) commission on a form prepared by the secretary with the approval of the ((~~board~~)) commission, detailing the education, training, and experience of the physician assistant and such other information as the ((~~board~~)) commission may require. The application shall be accompanied by a fee determined by the secretary as provided in RCW 43.70.250. Each applicant shall furnish proof satisfactory to the ((~~board~~)) commission of the following:

(a) That the applicant has completed an accredited physician assistant program approved by the ((~~board~~)) commission and is eligible to take the examination approved by the ((~~board~~)) commission;

(b) That the applicant is of good moral character; and

(c) That the applicant is physically and mentally capable of practicing medicine as a physician assistant with reasonable skill and safety. The ((~~board~~)) commission may require an applicant to submit to such examination or examinations as it deems necessary to determine an applicant's physical or mental capability, or both, to safely practice as a physician assistant.

(4) The ((~~board~~)) commission may approve, deny, or take other disciplinary action upon the application for license as provided in the Uniform Disciplinary Act, chapter 18.130 RCW. The license shall be renewed on a periodic basis as determined by the secretary under RCW 43.70.280, upon payment of a fee determined by the secretary as provided in RCW 43.70.250, and submission of a completed renewal application, in addition to any late renewal penalty fees as determined by the secretary as provided in RCW 43.70.250. The ((~~board~~)) commission may authorize the use of alternative supervisors who are licensed either under chapter 18.57 or 18.71 RCW.

Sec. 620. RCW 18.71A.030 and 1993 c 28 s 6 are each amended to read as follows:

A physician assistant ((~~as defined in this chapter~~)) may practice medicine in this state only with the approval of the practice arrangement plan by the ((~~board~~)) commission and only to the extent permitted by the ((~~board~~)) commission. A physician assistant who has received a license but who has not received ((~~board~~)) commission approval of the practice arrangement plan under RCW 18.71A.040 may not practice. A physician assistant shall be subject to discipline under chapter 18.130 RCW.

Sec. 621. RCW 18.71A.040 and 1993 c 28 s 7 are each amended to read as follows:

(1) No physician assistant practicing in this state shall be employed or supervised by a physician or physician group without the approval of the ((~~board~~)) commission.

(2) Prior to commencing practice, a physician assistant licensed in this state shall apply to the ((~~board~~)) commission for permission to be employed or supervised by a physician or physician group. The practice arrangement plan shall be jointly submitted by the physician or physician group and physician assistant. The secretary may charge a fee as provided in RCW 43.70.250 to recover the cost for the plan review. The practice arrangement plan shall delineate the manner and extent to which the physician assistant would practice and be supervised. Whenever a physician assistant is practicing in a manner inconsistent with the approved practice arrangement plan, the medical disciplinary board may take disciplinary action under chapter 18.130 RCW.

Sec. 622. RCW 18.71A.045 and 1988 c 113 s 2 are each amended to read as follows:

Foreign medical school graduates shall not be eligible for ((~~registration~~)) licensing as physician assistants after July 1, 1989. ((Those applying on or before that date shall remain eligible to register as a physician assistant after July 1, 1989: PROVIDED, That the graduate does not violate chapter 18.130 RCW or the rules of the board. The board shall adopt rules regarding applications for registration. The rules shall include board approval of training as required in RCW 18.71.051(1) and receipt of original translated transcripts directly from the medical school.))

Sec. 623. RCW 18.71A.050 and 1993 c 28 s 8 are each amended to read as follows:

No physician who supervises a licensed physician assistant in accordance with and within the terms of any permission granted by the ((~~medical examining board shall be~~)) commission is considered as aiding and abetting an unlicensed person to practice medicine. The supervising physician and physician assistant shall retain professional and personal responsibility for any act which constitutes the practice of medicine as defined in RCW 18.71.011 when performed by the physician assistant.

Sec. 624. RCW 18.71A.060 and 1990 c 196 s 6 are each amended to read as follows:

No health care services may be performed under this chapter in any of the following areas:

(1) The measurement of the powers or range of human vision, or the determination of the accommodation and refractive state of the human eye or the scope of its functions in general, or the fitting or adaptation of lenses or frames for the aid thereof.

(2) The prescribing or directing the use of, or using, any optical device in connection with ocular exercises, visual training, vision training, or orthoptics.

(3) The prescribing of contact lenses for, or the fitting or adaptation of contact lenses to, the human eye.

(4) Nothing in this section shall preclude the performance of routine visual screening.

(5) The practice of dentistry or dental hygiene as defined in chapters 18.32 and 18.29 RCW respectively. The exemptions set forth in RCW 18.32.030((~~, paragraphs~~)) (1) and (8), shall not apply to a physician assistant.

(6) The practice of chiropractic as defined in chapter 18.25 RCW including the adjustment or manipulation of the articulations of the spine.

(7) The practice of ((~~podiatry~~)) podiatric medicine and surgery as defined in chapter 18.22 RCW.

Sec. 625. RCW 18.71A.085 and 1990 c 196 s 10 are each amended to read as follows:

Any physician assistant acupuncturist currently licensed by the ((~~board~~)) commission may continue to perform acupuncture under the physician assistant license as long as he or she maintains licensure as a physician assistant.

Sec. 626. RCW 18.72.155 and 1991 c 3 s 168 are each amended to read as follows:

The secretary of the department of health shall appoint, from a list of three names supplied by the ((~~board~~)) commission, an executive ((~~secretary~~)) director who shall act to carry out the provisions of this chapter. The secretary shall also employ such additional staff including administrative assistants, investigators, and clerical staff as are required to enable the ((~~board~~)) commission to accomplish its duties and responsibilities. The executive ((~~secretary shall be~~)) director is exempt from the provisions of the civil service law, chapter 41.06 RCW, as now or hereafter amended.

Sec. 627. 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 this chapter ((~~18.71 RCW~~)) shall report to the ((~~medical disciplinary board~~)) commission 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~~)) commission may impose disciplinary sanctions, including license suspension or revocation, on any health care professional subject to the jurisdiction of the ((~~board~~)) commission who has failed to comply with this section.

Sec. 628. 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 or her 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~~)) commission, 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~~)) commission'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~~)) commission under 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. 629. RCW 18.72.301 and 1989 c 119 s 1 are each amended to read as follows:

Unless the context clearly requires otherwise, the definitions in this section apply throughout RCW 18.72.306 through 18.72.321 (as recodified by this act).

(1) ((~~"Board" means the medical disciplinary board of this state.~~

~~(2)~~)) "Committee" means a nonprofit corporation formed by physicians who have expertise in the areas of alcoholism, drug abuse, or mental illness and who broadly represent the physicians of the state and that has been designated to perform any or all of the activities set forth in RCW 18.72.306(1) (as recodified by this act) pursuant to rules adopted by the ((~~board~~)) commission under chapter 34.05 RCW.

((~~(3)~~)) (2) "Impaired" or "impairment" means the presence of the diseases of alcoholism, drug abuse, mental illness, or other debilitating conditions.

((~~(4)~~)) (3) "Impaired physician program" means the program for the prevention, detection, intervention, and monitoring of impaired physicians established by the ((~~board~~)) commission pursuant to RCW 18.72.306(1) (as recodified by this act).

((~~(5)~~)) (4) "Physician" means a person licensed under this chapter ((~~18.71 RCW~~)).

((~~(6)~~)) (5) "Treatment program" means a plan of care and rehabilitation services provided by those organizations or persons authorized to provide such services to be approved by the ((~~board~~)) commission for impaired physicians taking part in the impaired physician program created by RCW 18.72.306 (as recodified by this act).

Sec. 630. RCW 18.72.306 and 1991 c 3 s 169 are each amended to read as follows:

(1) The ((~~board~~)) commission shall enter into a contract with the committee to implement an impaired physician program. The impaired physician 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;

(d) Referring impaired physicians to treatment programs;

(e) Monitoring the treatment and rehabilitation of impaired physicians including those ordered by the ((~~board~~)) commission;

(f) Providing post-treatment monitoring and support of rehabilitative impaired physicians;

(g) Performing such other activities as agreed upon by the ((~~board~~)) commission and the committee; and

(h) Providing prevention and education services.

(2) A contract entered into under subsection (1) of this section shall be financed by a surcharge of up to twenty-five dollars on each license renewal or issuance of a new license to be collected by the department of health from every physician and surgeon licensed under this chapter ((~~18.71 RCW~~)) in addition to other license fees ((~~and the medical discipline assessment fee established under RCW 18.72.380~~)). These moneys shall be placed in the health professions account to be used solely for the implementation of the impaired physician program.

Sec. 631. RCW 18.72.311 and 1987 c 416 s 3 are each amended to read as follows:

The committee shall develop procedures in consultation with the ((~~board~~)) commission for:

(1) Periodic reporting of statistical information regarding impaired physician activity;

(2) Periodic disclosure and joint review of such information as the ((~~board~~)) commission may deem appropriate regarding reports received, contacts or investigations made, and the disposition of each report: PROVIDED, That the committee shall not disclose any personally identifiable information except as provided in subsections (3) and (4) of this section;

(3) Immediate reporting to the ((~~board~~)) commission of the name and results of any contact or investigation regarding any impaired physician who is believed to constitute an imminent danger to the public;

(4) Reporting to the ((~~board~~)) commission, in a timely fashion, any impaired physician who refuses to cooperate with the committee, refuses to submit to treatment, or whose impairment is not substantially alleviated through treatment, and who, in the opinion of the committee, is unable to practice medicine with reasonable skill and safety. However, impairment, in and of itself, shall not give rise to a presumption of the inability to practice medicine with reasonable skill and safety;

(5) Informing each participant of the impaired physician program of the program procedures, the responsibilities of program participants, and the possible consequences of noncompliance with the program.

Sec. 632. RCW 18.72.316 and 1987 c 416 s 4 are each amended to read as follows:

If the ((~~board~~)) commission has reasonable cause to believe that a physician is impaired, the ((~~board~~)) commission shall cause an evaluation of such physician to be conducted by the committee or the committee's designee or the ((~~board's~~)) commission's designee for the purpose of determining if there is an impairment. The committee or appropriate designee shall report the findings of its evaluation to the ((~~board~~)) commission.

Sec. 633. RCW 18.72.340 and 1993 c 367 s 17 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~~)) commission of all malpractice settlements, awards, or payments in excess of twenty 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 five-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. 634. RCW 18.72.345 and 1991 c 215 s 2 are each amended to read as follows:

To assist in identifying impairment related to alcohol abuse, the ((~~board~~)) commission may obtain a copy of the driving record of a physician or a physician assistant maintained by the department of licensing.

NEW SECTION. Sec. 635. (1) RCW 18.72.155, 18.72.165, 18.72.265, 18.72.301, 18.72.306, 18.72.311, 18.72.316, 18.72.340, and 18.72.345, as amended by this act, are each recodified as sections in chapter 18.71 RCW.

(2) RCW 18.72.010 and 18.72.321 are each recodified as sections in chapter 18.71 RCW.

NEW SECTION. Sec. 636. The following acts or parts of acts are each repealed:

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

(2) RCW 18.72.045 and 1991 c 215 s 1;

(3) RCW 18.72.090 and 1955 c 202 s 9;

(4) RCW 18.72.100 and 1991 c 3 s 166, 1984 c 287 s 45, 1979 ex.s. c 111 s 3, 1979 c 158 s 59, 1975-'76 2nd ex.s. c 34 s 42, & 1955 c 202 s 10;

(5) RCW 18.72.110 and 1955 c 202 s 11;

(6) RCW 18.72.120 and 1991 c 3 s 167 & 1955 c 202 s 12;

(7) RCW 18.72.130 and 1979 ex.s. c 111 s 4 & 1955 c 202 s 13;

(8) 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;

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

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

(11) RCW 18.72.380 and 1993 c 367 s 18, 1991 c 3 s 170, 1985 c 7 s 62, & 1983 c 71 s 1;

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

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

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

(15) RCW 18.72.910 and 1955 c 202 s 48.

CHIROPRACTIC QUALITY ASSURANCE COMMISSION

NEW SECTION. Sec. 637. A new section is added to chapter 18.25 RCW to read as follows:

This chapter is enacted:

(1) In the exercise of the police power of the state and to provide an adequate public agency to act as a disciplinary body for the members of the chiropractic profession licensed to practice chiropractic in this state;

(2) Because the health and well-being of the people of this state are of paramount importance;

(3) Because the conduct of members of the chiropractic profession licensed to practice chiropractic in this state plays a vital role in preserving the health and well-being of the people of the state; and

(4) Because practicing other healing arts while licensed to practice chiropractic and while holding one's self out to the public as a chiropractor affects the health and welfare of the people of the state.

It is the purpose of the commission established under section 640 of this act to regulate the competency and quality of professional health care providers under its jurisdiction by establishing, monitoring, and enforcing qualifications for licensing, consistent standards of practice, continuing competency mechanisms, and discipline. Rules, policies, and procedures developed by the commission must promote the delivery of quality health care to the residents of the state.

The legislature finds and declares that the costs of health care to the people are rising disproportionately to other costs and that there is a paramount concern that the right of the people to obtain access to health care in all its facets is being impaired thereby. For this reason, the reliance on the mechanism of health care service contractors, whether profit or nonprofit, is the only effective manner in which the large majority of the people can attain access to quality health care, and it is therefore declared to be in the public interest that health care service contractors be regulated to assure that all the people have access to health care to the greatest extent possible. RCW 18.25.130 through 18.25.170 (as recodified by this act), prohibiting discrimination against the legally recognized and licensed profession of chiropractic, are necessary in the interest of the public health, welfare, and safety.

Sec. 638. 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~~)) quality assurance commission 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. 639. 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.~~)) "Commission" means the Washington state chiropractic quality assurance commission.

(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.

NEW SECTION. Sec. 640. A new section is added to chapter 18.25 RCW to read as follows:

COMMISSION ESTABLISHED‑-MEMBERS APPOINTED BY THE GOVERNOR. The Washington state chiropractic quality assurance commission is established, consisting of fourteen members appointed by the governor to four-year terms, and including eleven practicing chiropractors and three public members. No member may serve more than two consecutive full terms. In appointing the initial members of the commission, it is the intent of the legislature that, to the extent possible, the governor appoint members of the previous boards and committees regulating this profession to the commission. Members of the commission hold office until their successors are appointed. The governor may appoint the members of the initial commissions to staggered terms of from one to four years. Thereafter, all members shall be appointed to full four-year terms. The governor may consider persons who are recommended for appointment by chiropractic associations of this state.

NEW SECTION. Sec. 641. A new section is added to chapter 18.25 RCW to read as follows:

COMMISSION‑-REMOVAL OF MEMBERS‑-VACANCIES. The governor may remove a member of the commission for neglect of duty, misconduct, or malfeasance or misfeasance in office. Whenever the governor is satisfied that a member of the commission has been guilty of neglect of duty, misconduct, or malfeasance or misfeasance in office, the governor shall file with the secretary of state a statement of the causes for and the order of removal from office, and the secretary shall forthwith send a certified copy of the order of removal and statement of causes by certified mail to the last known post office address of the member. If a vacancy occurs on the commission, the governor shall appoint a replacement to fill the remainder of the unexpired term.

NEW SECTION. Sec. 642. A new section is added to chapter 18.25 RCW to read as follows:

COMMISSION‑-QUALIFICATIONS OF MEMBERS. Members must be citizens of the United States and residents of this state. Members must be licensed chiropractors for a period of five years before appointment. Public members of the commission may not be a member of any other health care licensing board or commission, or have a fiduciary obligation to a facility rendering health services regulated by the commission, or have a material or financial interest in the rendering of health services regulated by the commission.

NEW SECTION. Sec. 643. A new section is added to chapter 18.25 RCW to read as follows:

COMMISSION‑-DUTIES AND POWERS. The commission shall elect a chairperson, vice-chairperson, and secretary each year. Meetings of the commission are open to the public, except that the commission may hold executive sessions to the extent permitted by chapter 42.30 RCW. The secretary of health shall furnish such secretarial, clerical, and other assistance as the commission may require.

A majority of the commission members appointed and serving constitutes a quorum for the transaction of commission business. The affirmative vote of a majority of a quorum of the commission is required to carry a motion or resolution, to adopt a rule, or to pass a measure.

The commission may appoint members of panels of at least three members. A quorum for transaction of any business by a panel is a minimum of three members. A majority vote of a quorum of the panel is required to transact business delegated to it by the commission.

The members of the commission are immune from suit in an action, civil or criminal, based upon its disciplinary proceedings or other official acts performed in good faith as members of the commission.

The commission may, whenever the workload of the commission requires, request that the secretary appoint pro tempore members. While serving as members pro tempore persons have all the powers, duties, and immunities, and are entitled to the emoluments, including travel expenses, of the commission.

The commission shall prepare or determine the nature of the examinations for applicants to practice chiropractic.

The commission may adopt such rules as are consistent with this chapter as may be deemed necessary and proper to carry out the purposes of this chapter.

Sec. 644. 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 discipline of licensees under this chapter.

Sec. 645. 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~~)) commission 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. 646. RCW 18.25.025 and 1980 c 51 s 3 are each amended to read as follows:

The ((~~board~~)) commission shall have authority to grant accreditation to chiropractic schools and colleges.

The ((~~board~~)) commission shall have authority to adopt educational standards which may include standards of any accreditation agency recognized by the office of education of the department of health and human services or its successor agency, or any portion of such standards, as the ((~~board's~~)) commission's standards: PROVIDED, That such standards, so adopted, shall contain, as a minimum of on-campus instruction in chiropractic, the following: Principles of chiropractic, two hundred hours; adjustive technique, four hundred hours; spinal roentgenology, one hundred seventy-five hours; symptomatology and diagnosis, four hundred twenty-five hours; clinic, six hundred twenty-five hours: PROVIDED FURTHER, That such standards shall not mandate, as a requirement for either graduation or accreditation, or include in the computation of hours of chiropractic instruction required by this section, instruction in the following: Mechanotherapy, physiotherapy, acupuncture, acupressure, or any other therapy.

The ((~~board~~)) commission shall approve and accredit chiropractic colleges and schools which apply for ((~~board~~)) commission accreditation and approval and which meet to the ((~~board's~~)) commission's satisfaction the educational standards adopted by the ((~~board~~)) commission. It shall be the responsibility of the college to apply for accreditation and approval, and of a student to ascertain whether a college or school has been accredited or approved by the ((~~board~~)) commission.

The ((~~board~~)) commission shall have authority to engage assistants in the giving of examinations called for under this chapter.

Sec. 647. 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~~)) commission 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~~)) commission 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~~)) commission 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~~)) commission may enact additional requirements for testing administered by the national board of chiropractic examiners.

Sec. 648. RCW 18.25.035 and 1971 ex.s. c 227 s 5 are each amended to read as follows:

The ((~~board~~)) commission may, in its discretion, waive any examination required by this chapter of persons applying for a license to practice chiropractic if, in its opinion, the applicant has successfully passed an examination conducted by the national board of chiropractic examiners of the United States that is of equal or greater difficulty than the examination being waived by the ((~~board~~)) commission.

Sec. 649. 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~~)) commission, and after such examination as may be required by rule of the ((~~board~~)) commission, 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. 650. 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~~)) commission. The commission may, for good cause shown, waive said attendance. The following guidelines for such symposiums shall apply:

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

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

(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 in this chapter, to ((~~said~~)) the 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~~)) If the licensee allows his or her license to ((~~elapse~~)) lapse 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~~)) commission.

Sec. 651. RCW 18.25.075 and 1991 c 3 s 41 are each amended to read as follows:

(1) An individual may place his or her license on inactive status. The holder of an inactive license shall not practice chiropractic in this state without first activating the license.

(3) An inactive license may be placed in an active status upon compliance with the rules established by the ((~~board~~)) commission.

(4) The provisions relating to the denial, suspension, and revocation of a license shall be applicable to an inactive license, except that when proceedings to suspend or revoke an inactive license have been initiated, the license shall remain inactive until the proceedings have been completed.

NEW SECTION. Sec. 652. A new section is added to chapter 18.25 RCW 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 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 prosecuted by the attorney general upon the direction of the commission.

Sec. 653. RCW 18.25.180 and 1991 c 222 s 9 are each amended to read as follows:

(1) A chiropractor may employ a technician to operate x-ray equipment after the technician has registered with the ((~~board~~)) commission.

(2) The ((~~board~~)) commission may adopt rules necessary and appropriate to carry out the purposes of this section.

Sec. 654. 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~~)) commission 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~~)) commission.

(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~~)) commission 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~~)) commission.

(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~~)) commission.

(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~~)) commission, except that the unlicensed chiropractor must provide all services under the direct control and supervision of a licensed chiropractor approved by the ((~~board~~)) commission. 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~~)) commission 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~~)) commission as provided in chapters 18.26 and 18.130 RCW.

NEW SECTION. Sec. 655. A new section is added to chapter 18.25 RCW to read as follows:

The commission is the successor in interest of the board of chiropractic examiners, the chiropractic disciplinary board, and the chiropractic peer review committee. All contracts, undertakings, agreements, rules, regulations, and policies of those bodies continue in full force and effect on the effective date of this act, unless otherwise repealed or rejected by chapter . . ., Laws of 1994 (this act) or by the commission.

NEW SECTION. Sec. 656. RCW 18.25.130, 18.25.140, 18.25.150, 18.25.160, and 18.25.170 are each recodified within chapter 18.25 RCW between RCW 18.25.019 and 18.25.020.

NEW SECTION. Sec. 657. 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 18.25.120 and 1974 ex.s. c 97 s 1;

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

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

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

(8) RCW 18.26.030 and 1986 c 259 s 25, 1979 ex.s. c 111 s 17, 1975 1st ex.s. c 39 s 1, 1974 ex.s. c 97 s 12, & 1967 c 171 s 3;

(9) RCW 18.26.040 and 1989 c 258 s 9 & 1980 c 46 s 1;

(10) RCW 18.26.050 and 1991 c 3 s 44, 1979 c 158 s 21, & 1967 c 171 s 5;

(11) RCW 18.26.060 and 1967 c 171 s 6;

(12) RCW 18.26.070 and 1991 c 3 s 45, 1984 c 287 s 28, & 1980 c 46 s 2;

(13) RCW 18.26.080 and 1967 c 171 s 8;

(14) RCW 18.26.090 and 1989 c 258 s 11 & 1967 c 171 s 9;

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

(16) RCW 18.26.320 and 1991 c 320 s 1;

(17) RCW 18.26.330 and 1991 c 320 s 2;

(18) RCW 18.26.340 and 1991 c 320 s 3;

(19) RCW 18.26.350 and 1991 c 320 s 4;

(20) RCW 18.26.360 and 1991 c 320 s 5;

(21) RCW 18.26.370 and 1991 c 320 s 6;

(22) RCW 18.26.380 and 1991 c 320 s 7;

(23) RCW 18.26.390 and 1991 c 320 s 11; and

(24) RCW 18.26.900 and 1967 c 171 s 31.

DENTAL QUALITY ASSURANCE COMMISSION

NEW SECTION. Sec. 658. A new section is added to chapter 18.32 RCW to read as follows:

The legislature finds that the health and well-being of the people of this state are of paramount importance.

The legislature further finds that the conduct of members of the dental profession licensed to practice dentistry in this state plays a vital role in preserving the health and well-being of the people of the state.

The legislature further finds that there is no effective means of handling disciplinary proceedings against members of the dental profession licensed in this state when such proceedings are necessary for the protection of the public health.

Therefore, the legislature declares its intention to exercise the police power of the state to protect the public health, to promote the welfare of the state, and to provide a commission to act as a disciplinary and regulatory body for the members of the dental profession licensed to practice dentistry in this state.

It is the purpose of the commission established in section 661 of this act to regulate the competency and quality of professional health care providers under its jurisdiction by establishing, monitoring, and enforcing qualifications for licensure, consistent standards of practice, continuing competency mechanisms, and discipline. Rules, policies, and procedures developed by the commission must promote the delivery of quality health care to the residents of the state.

Sec. 659. 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~~)) commission" used in this chapter shall mean the Washington state ((~~board of dental examiners~~)) dental quality assurance commission; and the term "secretary" shall mean the secretary of health of the state of Washington.

Sec. 660. 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~~)) commission, when acting under the direction and supervision of Washington state-licensed dental school faculty;

(4) The practice of dentistry by licensed dentists of other states or countries while appearing as clinicians at meetings of the Washington state dental association, or component parts thereof, or at meetings sanctioned by them, or other groups approved by the ((~~board of dental examiners~~)) commission;

(5) The use of roentgen and other rays for making radiographs or similar records of dental or oral tissues, under the supervision of a licensed dentist or physician;

(6) The making, repairing, altering, or supplying of artificial restorations, substitutions, appliances, or materials for the correction of disease, loss, deformity, malposition, dislocation, fracture, injury to the jaws, teeth, lips, gums, cheeks, palate, or associated tissues or parts; providing the same are made, repaired, altered, or supplied pursuant to the written instructions and order of a licensed dentist which may be accompanied by casts, models, or impressions furnished by the dentist, and the prescriptions shall be retained and filed for a period of not less than three years and shall be available to and subject to the examination of the secretary or the secretary's authorized representatives;

(7) The removal of deposits and stains from the surfaces of the teeth, the application of topical preventative or prophylactic agents, and the polishing and smoothing of restorations, when performed or prescribed by a dental hygienist licensed under the laws of this state;

(8) A qualified and licensed physician and surgeon 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.

NEW SECTION. Sec. 661. A new section is added to chapter 18.32 RCW to read as follows:

COMMISSION ESTABLISHED‑-MEMBERS APPOINTED. The Washington state dental quality assurance commission is established, consisting of fifteen members each appointed by the governor to a four-year term. No member may serve more than two consecutive full terms. In appointing the initial members of the commission, it is the intent of the legislature that, to the extent possible, members of the previous boards and committees regulating these professions be appointed to the commission. Members of the commission hold office until their successors are appointed. The governor may appoint members of the initial commission to staggered terms of from one to four years. Thereafter, all members shall be appointed to full four-year terms. Twelve members of the commission must be dentists, two members must be public members, and one nonvoting member must be a licensed dental hygienist.

NEW SECTION. Sec. 662. A new section is added to chapter 18.32 RCW to read as follows:

NEW SECTION. Sec. 663. A new section is added to chapter 18.32 RCW to read as follows:

COMMISSION‑-QUALIFICATIONS OF MEMBERS. Members must be citizens of the United States and residents of this state. Dentist members must be licensed dentists in the active practice of dentistry for a period of five years before appointment. Of the twelve dentists appointed to the commission, at least four must reside and engage in the active practice of dentistry east of the summit of the Cascade mountain range. Public members of the commission may not be a member of any other health care licensing board or commission, or have a fiduciary obligation to a facility rendering health services regulated by the commission, or have a material or financial interest in the rendering of health services regulated by the commission. The dental hygienist member must be in the active practice of dental hygiene in this state for a period of five years before appointment to the commission, and at the time of initial appointment, be a member of the Washington state dental hygiene examining committee. No person is eligible to appointment to the commission who is in any way connected with a dental college or dental department of an institution of learning.

NEW SECTION. Sec. 664. A new section is added to chapter 18.32 RCW to read as follows:

COMMISSION‑-DUTIES AND POWERS. The commission shall elect a chairperson, vice-chairperson, and secretary each year. Meetings of the commission are open to the public, except the commission may hold executive sessions to the extent permitted by chapter 42.30 RCW. The secretary of health shall furnish such secretarial, clerical, and other assistance as the commission may require.

The commission may appoint members of panels consisting of not less than three members. A quorum for transaction of any business shall be a minimum of three members. A majority vote of a quorum of the panel is required to transact business delegated to it by the commission.

The commission shall prepare or determine the nature of the examinations for applicants to practice dentistry.

The attorney general shall advise the commission and represent it in all legal proceedings.

NEW SECTION. Sec. 665. A new section is added to chapter 18.32 RCW to read as follows:

Each member of the commission shall be compensated in accordance with RCW 43.03.240. Members shall be reimbursed for travel expenses incurred in the actual performance of their duties, as provided in RCW 43.03.050 and 43.03.060. Commission members shall be compensated and reimbursed for their activities in developing or administering a multistate licensing examination, as provided in this chapter.

NEW SECTION. Sec. 666. A new section is added to chapter 18.32 RCW to read as follows:

The commission may contract with competent persons on a temporary basis to assist in developing or administering examinations for licensure.

The commission may enter into compacts and agreements with other states and with organizations formed by several states, for the purpose of conducting multistate licensing examinations. The commission may enter into the compacts and agreements even though they would result in the examination of a candidate for a license in this state by an examiner or examiners from another state or states, and even though the compacts and agreements would result in the examination of a candidate or candidates for a license in another state or states by an examiner or examiners from this state.

NEW SECTION. Sec. 667. A new section is added to chapter 18.32 RCW to read as follows:

The commission may adopt rules in accordance with chapter 34.05 RCW to implement this chapter and chapter 18.130 RCW.

Sec. 668. RCW 18.32.040 and 1991 c 3 s 61 are each amended to read as follows:

The ((~~board~~)) commission shall require that every applicant for a license to practice dentistry shall:

(1) Present satisfactory evidence of graduation from a dental college, school, or dental department of an institution approved by the ((~~board~~)) commission;

(2) Submit, for the files of the ((~~board~~)) commission, a recent picture duly identified and attested; and

(3) Pass an examination prepared or approved by and administered under the direction of the ((~~board~~)) commission. The dentistry licensing examination shall consist of practical and written tests upon such subjects and of such scope as the ((~~board~~)) commission determines. The ((~~board~~)) commission may accept, in lieu of all or part of a written examination, a certificate granted by a national or regional testing organization approved by the ((~~board~~)) commission. The ((~~board~~)) commission shall set the standards for passing the examination. The secretary shall keep on file the examination papers and records of examination for at least one year. This file shall be open for inspection by the applicant or the applicant's agent unless the disclosure will compromise the examination process as determined by the ((~~board~~)) commission or is exempted from disclosure under RCW 42.17.250 through 42.17.340.

Sec. 669. RCW 18.32.050 and 1984 c 287 s 30 are each amended to read as follows:

((The members of the board shall each be compensated in accordance with RCW 43.03.240 and shall be reimbursed for travel expenses incurred in attending the meetings of the board in accordance with RCW 43.03.050 and 43.03.060. Board)) Commission members shall be compensated and reimbursed pursuant to this section for their activities in administering a multi-state licensing examination pursuant to the ((~~board's~~)) commission's compact or agreement with another state or states or with organizations formed by several states((~~: PROVIDED, That any~~)). Compensation or reimbursement received by a ((~~board~~)) commission member from another state, or organization formed by several states, for such member's services in administering a multi-state licensing examination, shall be deposited in the state general fund.

Sec. 670. RCW 18.32.100 and 1991 c 3 s 62 are each amended to read as follows:

The applicant for a dentistry license shall file an application on a form furnished by the secretary, stating the applicant's name, age, place of residence, the name of the school or schools attended by the applicant, the period of such attendance, the date of the applicant's graduation, whether the applicant has ever been the subject of any disciplinary action related to the practice of dentistry, and shall include a statement of all of the applicant's dental activities. This shall include any other information deemed necessary by the ((~~board~~)) commission.

The application shall be signed by the applicant and sworn to by the applicant before some person authorized to administer oaths, and shall be accompanied by proof of the applicant's school attendance and graduation.

Sec. 671. RCW 18.32.120 and 1991 c 3 s 64 are each amended to read as follows:

When the application and the accompanying proof are found satisfactory, the secretary shall notify the applicant to appear before the ((~~board~~)) commission at a time and place to be fixed by the ((~~board~~)) commission.

The examination papers, and all grading thereon, and the grading of the practical work, shall be preserved for a period of not less than one year after the ((~~board~~)) commission has made and published its decisions thereon. All examinations shall be conducted by the ((~~board~~)) commission under fair and wholly impartial methods.

Any applicant who fails to make the required grade by his or her fourth examination may be reexamined only under rules adopted by the ((~~board~~)) commission.

Applicants for examination or reexamination shall pay a fee as determined by the secretary as provided in RCW 43.70.250.

Sec. 672. RCW 18.32.160 and 1991 c 3 s 65 are each amended to read as follows:

All licenses issued by the secretary on behalf of the ((~~board~~)) commission shall be signed by the secretary or chairperson and secretary of the ((~~board~~)) commission.

Sec. 673. RCW 18.32.180 and 1991 c 3 s 67 are each amended to read as follows:

(1) Every person licensed to practice dentistry in this state shall register with the secretary, and pay a renewal registration fee determined by the secretary as provided in RCW 43.70.250. Any failure to register and pay the renewal registration fee renders the license invalid, and the practice of dentistry shall not be permitted. The license shall be reinstated upon written application to the secretary and payment to the state of a penalty fee determined by the secretary as provided in RCW 43.70.250, together with all delinquent license renewal fees.

(2) A person who fails to renew the license for a period of three years may not renew the license under subsection (1) of this section. In order to obtain a license to practice dentistry in this state, such a person shall file an original application as provided for in this chapter, along with the requisite fees. The ((~~board~~)) commission, in its sole discretion, may permit the applicant to be licensed without examination, and with or without conditions, if it is satisfied that the applicant meets all the requirements for licensure in this state and is competent to engage in the practice of dentistry.

Sec. 674. RCW 18.32.190 and 1991 c 3 s 68 are each amended to read as follows:

Every person who engages in the practice of dentistry in this state shall cause his or her license to be, at all times, displayed in a conspicuous place, in his or her office wherein he or she shall practice such profession, and shall further, whenever requested, exhibit such license to any of the members of ((~~said board~~)) the commission, or its authorized agent, and to the secretary or his or her authorized agent. Every licensee shall notify the secretary of the address or addresses, and of every change thereof, where the licensee shall engage in the practice of dentistry.

Sec. 675. RCW 18.32.195 and 1992 c 59 s 1 are each amended to read as follows:

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

(1) The ((~~board~~)) commission 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~~)) commission 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~~)) commission may condition the granting of a license under this section with terms the ((~~board~~)) commission deems appropriate. All persons licensed under this section shall be subject to the jurisdiction of the ((~~dental disciplinary board~~)) commission 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~~)) commission after a hearing has been held in accordance with the provisions set forth in this chapter, and determination by the ((~~dental disciplinary board~~)) commission 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~~)) commission, 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~~)) commission. 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. 676. RCW 18.32.215 and 1989 c 202 s 30 are each amended to read as follows:

An applicant holding a valid license and currently engaged in practice in another state may be granted a license without examination required by this chapter, on the payment of any required fees, if the ((~~board~~)) commission determines that the other state's licensing standards are substantively equivalent to the standards in this state((~~: PROVIDED, That~~)). The ((~~board~~)) commission may also require the applicant to: (1) File with the ((~~board~~)) commission documentation certifying the applicant is licensed to practice in another state; and (2) provide information as the ((~~board~~)) commission deems necessary pertaining to the conditions and criteria of the Uniform Disciplinary Act, chapter 18.130 RCW, and to demonstrate to the ((~~board~~)) commission a knowledge of Washington law pertaining to the practice of dentistry.

Sec. 677. RCW 18.32.534 and 1991 c 3 s 72 are each amended to read as follows:

(1) To implement an impaired dentist program as authorized by RCW 18.130.175, the ((~~dental disciplinary board~~)) commission shall enter into a contract with a voluntary substance abuse monitoring program. The impaired dentist 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;

(d) Referring impaired dentists to treatment programs;

(e) Monitoring the treatment and rehabilitation of impaired dentists including those ordered by the ((~~board~~)) commission;

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

(g) Performing other related activities as determined by the ((~~board~~)) commission.

(2) A contract entered into under subsection (1) of this section shall be financed by a surcharge of up to fifteen dollars on each license issuance or renewal to be collected by the department of health from every dentist licensed under chapter 18.32 RCW. These moneys shall be placed in the health professions account to be used solely for the implementation of the impaired dentist program.

Sec. 678. RCW 18.32.640 and 1988 c 217 s 1 are each amended to read as follows:

(1) The ((~~board~~)) commission may adopt((~~, amend, and rescind~~)) such rules as it deems necessary to carry out this chapter.

(2) The ((~~board~~)) commission may adopt rules governing administration of sedation and general anesthesia by persons licensed under this chapter, including necessary training, education, equipment, and the issuance of any permits, certificates, or registration as required.

Sec. 679. 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~~)) commission shall:

(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~~)) commission but not more than three years, and ((to)) may require the production of all such records for examination by the ((~~board~~)) commission 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~~)) commission 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. 680. RCW 18.32.665 and 1986 c 259 s 36 are each amended to read as follows:

It shall be unlawful for any person, firm, or corporation to publish, directly or indirectly, or circulate any fraudulent, false, or misleading statements within the state of Washington as to the skill or method of practice of any person or operator; or in any way to advertise in print any matter with a view of deceiving the public, or in any way that will tend to deceive or defraud the public; or to claim superiority over neighboring dental practitioners; or to publish reports of cases or certificates of same in any public advertising media; or to advertise as using any anesthetic, drug, formula, medicine, which is either falsely advertised or misnamed; or to employ "capper" or "steerers" to obtain patronage; and any person committing any offense against any of the provisions of this section shall, upon conviction, be subjected to such penalties as are provided in this chapter: PROVIDED, That any person licensed under this chapter may announce credit, terms of credit or installment payments that may be made at periodical intervals to apply on account of any dental service rendered. The ((~~dental disciplinary board~~)) commission may adopt such rules as are necessary to carry out the intent of this section.

Sec. 681. RCW 18.32.745 and 1991 c 3 s 73 are each amended to read as follows:

No manager, proprietor, partnership, or association owning, operating, or controlling any room, office, or dental parlors, where dental work is done, provided, or contracted for, shall employ or retain any unlicensed person or dentist as an operator; nor shall fail, within ten days after demand made by the secretary of health((,)) or the ((~~state board of dental examiners, or the dental disciplinary board~~)) commission in writing sent by certified mail, addressed to any such manager, proprietor, partnership, or association at ((~~said~~)) the room, office, or dental parlor, to furnish the secretary of health((,)) or the ((~~state board of dental examiners, or the dental disciplinary board~~)) commission with the names and addresses of all persons practicing or assisting in the practice of dentistry in his or her place of business or under his or her control, together with a sworn statement showing by what license or authority ((~~said~~)) the persons are practicing dentistry.

The sworn statement shall not be used as evidence in any subsequent court proceedings, except in a prosecution for perjury connected with its execution.

Any violation of the provisions of this section ((~~shall constitute~~)) is improper, unprofessional, and dishonorable conduct; it ((~~shall~~)) also ((~~constitute~~)) is grounds for injunction proceedings as provided by this chapter, and in addition ((~~shall constitute~~)) is a gross misdemeanor, except that the failure to furnish the information as may be requested in accordance with this section ((~~shall constitute~~)) is a misdemeanor.

Sec. 682. RCW 18.32.755 and 1986 c 259 s 37 are each amended to read as follows:

Any advertisement or announcement for dental services must include for each office location advertised the names of all persons practicing dentistry at that office location.

Any violation of the provisions of this section ((~~shall constitute~~)) is improper, unprofessional, and dishonorable conduct; it ((~~shall~~)) also ((~~constitute~~)) is grounds for injunction proceedings as provided by RCW 18.130.190((~~(2)~~)) (4), and in addition ((~~shall constitute~~)) is a gross misdemeanor.

NEW SECTION. Sec. 683. A new section is added to chapter 18.32 RCW to read as follows:

The commission is the successor in interest of the board of dental examiners and the dental disciplinary board. All contracts, undertakings, agreements, rules, regulations, and policies continue in full force and effect on the effective date of this act, unless otherwise repealed or rejected by chapter ..., Laws of 1994 (this act) or by the commission.

NEW SECTION. Sec. 684. The following acts or parts of acts are each repealed:

(1) 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;

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

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

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

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

(6) 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;

(7) RCW 18.32.560 and 1984 c 279 s 51 & 1977 ex.s. c 5 s 6;

(8) RCW 18.32.570 and 1977 ex.s. c 5 s 7;

(9) RCW 18.32.580 and 1977 ex.s. c 5 s 8;

(10) RCW 18.32.590 and 1977 ex.s. c 5 s 9;

(11) RCW 18.32.600 and 1984 c 287 s 31 & 1977 ex.s. c 5 s 10;

(12) RCW 18.32.610 and 1977 ex.s. c 5 s 11; and

(13) RCW 18.32.620 and 1984 c 279 s 62 & 1977 ex.s. c 5 s 12.

PART VII - TIMELINES

NEW SECTION. Sec. 701. A new section is added to chapter 18.130 RCW to read as follows:

TIMELINES FOR ASSESSMENT, INVESTIGATION, CHARGING, DISCOVERY, SETTLEMENT, AND ADJUDICATION OF COMPLAINTS. By July 1, 1995, the secretary, after consultation with the boards and commissions under RCW 18.130.040, shall establish in rule timelines for the consistent application of this chapter to all persons subject to this chapter. These timelines shall include but not be limited to specific time periods for assessment, investigation, charging, discovery, settlement, and adjudication of complaints, and shall include enforcement provisions for violations of the specific time periods by the department or the disciplinary authority.

PART VIII - MISCELLANEOUS

NEW SECTION. Sec. 801. CAPTIONS. Captions as used in this act constitute no part of the law.

NEW SECTION. Sec. 802. 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.