AN
ACT Relating to treatment programs for impaired physicians; amending RCW
18.71.0195, 18.71.300, 18.71.310, 18.71.320, 18.71.330, 18.71.340, 18.130.070,
18.130.080, 18.130.175, 18.130.300, 18.57A.020, and 18.71A.020; adding a new
section to chapter 18.71 RCW; and creating a new section.
BE IT
ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
NEW
SECTION. Sec. 1. The
legislature finds that the self-imposed license surcharge on physician licenses
to fund a program to help physicians with chemical dependency or mental illness
is not being fully spent on that program. It is the intent of the legislature
that the program be fully funded and that funds collected into the impaired
physician account be spent only on the program.
Sec.
2. RCW
18.71.0195 and 1994 sp.s. c 9 s 328 are each amended to read as follows:
(1)
The contents of any report ((file)) filed 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 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 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)), or
the entity established by RCW 18.71.300 and its officers, agents, and employees
are immune from civil liability, whether direct or derivative, for
providing information to the 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.
Sec.
3. RCW
18.71.300 and 1994 sp.s. c 9 s 329 are each amended to read as follows:
((Unless
the context clearly requires otherwise,)) The definitions in this
section apply throughout RCW 18.71.310 through 18.71.340 unless the context
clearly requires otherwise.
(1)
(("Committee")) "Entity" means a nonprofit
corporation formed by physicians who have expertise in the areas of ((alcoholism))
alcohol abuse, drug abuse, ((or)) alcoholism, other drug
addictions, and 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 18.71.310(1) ((pursuant to rules adopted)) by the
commission ((under chapter 34.05 RCW)).
(2)
"Impaired" or "impairment" means the ((presence of the
diseases of alcoholism, drug abuse, mental illness)) inability to
practice medicine with reasonable skill and safety to patients by reason of
physical or mental illness including alcohol abuse, drug abuse, alcoholism,
other drug addictions, or other debilitating conditions.
(3)
"Impaired physician program" means the program for the prevention,
detection, intervention, ((and)) monitoring, and treatment of
impaired physicians established by the commission pursuant to RCW 18.71.310(1).
(4)
"Physician" or "practitioner" means a person
licensed under this chapter, chapter 18.71A RCW, or a professional licensed
under another chapter of Title 18 RCW whose disciplining authority has a contract
with the entity for an impaired practitioner program for its license holders.
(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 commission or entity for impaired physicians
taking part in the impaired physician program created by RCW 18.71.310.
Sec.
4. RCW
18.71.310 and 1997 c 79 s 2 are each amended to read as follows:
(1)
The commission shall enter into a contract with the ((committee)) entity
to implement an impaired physician program. The commission may enter into a
contract with the entity for up to six years in length. The impaired
physician program may include any or all of the following:
(a)
((Contracting)) Entering into relationships supportive of the
impaired physician program with ((providers of)) professionals
who provide either evaluation or treatment ((programs)) services,
or both;
(b)
Receiving and ((evaluating)) assessing reports of suspected
impairment from any source;
(c)
Intervening in cases of verified impairment, or in cases where there is
reasonable cause to suspect impairment;
(d)
Upon reasonable cause, referring suspected or verified impaired
physicians ((to)) for evaluation or treatment ((programs));
(e)
Monitoring the treatment and rehabilitation of impaired physicians including
those ordered by the commission;
(f)
Providing ((post-treatment)) monitoring and continuing treatment and
rehabilitative support of ((rehabilitative impaired)) physicians;
(g)
Performing such other activities as agreed upon by the commission and the ((committee))
entity; 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 per year 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 in addition
to other license fees. These moneys shall be placed in the ((health
professions)) impaired physician account to be used solely for the
implementation of the impaired physician program.
Sec.
5. RCW
18.71.320 and 1994 sp.s. c 9 s 331 are each amended to read as follows:
The
((committee)) entity shall develop procedures in consultation
with the commission for:
(1)
Periodic reporting of statistical information regarding impaired physician
activity;
(2)
Periodic disclosure and joint review of such information as the commission may
deem appropriate regarding reports received, contacts or investigations made,
and the disposition of each report((: PROVIDED, That)). However,
the ((committee)) entity shall not disclose any personally
identifiable information except as provided in subsections (3) and (4) of this
section;
(3)
Immediate reporting to the commission of the name and results of any contact or
investigation regarding any suspected or verified impaired physician who
is reasonably believed probably to constitute an imminent danger
to himself or herself or to the public;
(4)
Reporting to the commission, in a timely fashion, any suspected or verified
impaired physician who ((refuses)) fails to cooperate with the ((committee,
refuses)) entity, fails to submit to evaluation or treatment,
or whose impairment is not substantially alleviated through treatment, ((and))
or who, in the opinion of the ((committee)) entity, is probably
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.
6. RCW
18.71.330 and 1994 sp.s. c 9 s 332 are each amended to read as follows:
If
the commission has reasonable cause to believe that a physician is impaired,
the commission shall cause an evaluation of such physician to be conducted by
the ((committee)) entity or the ((committee's)) entity's
designee or the commission's designee for the purpose of determining if there
is an impairment. The ((committee)) entity or appropriate
designee shall report the findings of its evaluation to the commission.
Sec.
7. RCW
18.71.340 and 1987 c 416 s 6 are each amended to read as follows:
All
((committee)) entity records are not subject to disclosure
pursuant to chapter 42.17 RCW.
Sec.
8. RCW
18.130.070 and 1989 c 373 s 19 are each amended to read as follows:
(1)
The disciplining authority may adopt rules requiring any person, including, but
not limited to, licensees, corporations, organizations, health care facilities,
impaired practitioner programs, or voluntary substance abuse monitoring
programs approved by the disciplining authority and state or local
governmental agencies, to report to the disciplining authority any conviction,
determination, or finding that a license holder has committed an act which
constitutes unprofessional conduct, or to report information to the
disciplining authority, an impaired practitioner program, or voluntary
substance abuse monitoring program approved by the disciplining authority,
which indicates that the license holder may not be able to practice his or her
profession with reasonable skill and safety to consumers as a result of a
mental or physical condition. To facilitate meeting the intent of this
section, the cooperation of agencies of the federal government is requested by
reporting any conviction, determination, or finding that a federal employee or
contractor regulated by the disciplinary authorities enumerated in this chapter
has committed an act which constituted unprofessional conduct and reporting any
information which indicates that a federal employee or contractor regulated by
the disciplinary authorities enumerated in this chapter may not be able to
practice his or her profession with reasonable skill and safety as a result of
a mental or physical condition.
(2)
If a person fails to furnish a required report, the disciplining authority may
petition the superior court of the county in which the person resides or is
found, and the court shall issue to the person an order to furnish the required
report. A failure to obey the order is a contempt of court as provided in chapter
7.21 RCW.
(3)
A person is immune from civil liability, whether direct or derivative, for
providing information to the disciplining authority pursuant to the rules
adopted under subsection (1) of this section.
(4) The holder of a license subject to the jurisdiction of this
chapter shall report to the disciplining authority any conviction,
determination, or finding that the licensee has committed unprofessional
conduct or is unable to practice with reasonable skill or safety. Failure to
report within thirty days of notice of the conviction, determination, or
finding constitutes grounds for disciplinary action.
Sec.
9. RCW
18.130.080 and 1986 c 259 s 5 are each amended to read as follows:
A person, including but not limited to consumers, licensees,
corporations, organizations, health care facilities, impaired practitioner
programs, or voluntary substance abuse monitoring programs approved by
disciplining authorities, and state and local governmental agencies, may
submit a written complaint to the disciplining authority charging a license
holder or applicant with unprofessional conduct and specifying the grounds
therefor or to report information to the disciplining authority, or
voluntary substance abuse monitoring program, or an impaired practitioner
program approved by the disciplining authority, which indicates that the
license holder may not be able to practice his or her profession with
reasonable skill and safety to consumers as a result of a mental or physical
condition. If the disciplining authority determines that the complaint
merits investigation, or if the disciplining authority has reason to believe,
without a formal complaint, that a license holder or applicant may have engaged
in unprofessional conduct, the disciplining authority shall investigate to
determine whether there has been unprofessional conduct. A person who files a
complaint or reports information under this section in good faith is
immune from suit in any civil action related to the filing or contents of the
complaint.
Sec.
10. RCW
18.130.175 and 1993 c 367 s 3 are each amended to read as follows:
(1)
In lieu of disciplinary action under RCW 18.130.160 and if the disciplining
authority determines that the unprofessional conduct may be the result of
substance abuse, the disciplining authority may refer the license holder to a
voluntary substance abuse monitoring program approved by the disciplining
authority.
The
cost of the treatment shall be the responsibility of the license holder, but
the responsibility does not preclude payment by an employer, existing insurance
coverage, or other sources. Primary alcoholism or other drug addiction
treatment shall be provided by approved treatment programs under RCW
70.96A.020((: PROVIDED, That)) or by any other provider approved by
the entity or the commission. However, nothing shall prohibit the
disciplining authority from approving additional services and programs as an
adjunct to primary alcoholism or other drug addiction treatment.
The disciplining authority may also approve the use of out-of-state programs.
Referral of the license holder to the program shall be done only with the
consent of the license holder. Referral to the program may also include
probationary conditions for a designated period of time. If the license holder
does not consent to be referred to the program or does not successfully
complete the program, the disciplining authority may take appropriate action
under RCW 18.130.160. The secretary shall adopt uniform rules for the
evaluation by the disciplinary authority of a relapse or program violation on
the part of a license holder in the substance abuse monitoring program. The
evaluation shall encourage program participation with additional conditions, in
lieu of disciplinary action, when the disciplinary authority determines that
the license holder is able to continue to practice with reasonable skill and
safety.
(2)
In addition to approving substance abuse monitoring programs that may receive
referrals from the disciplining authority, the disciplining authority may
establish by rule requirements for participation of license holders who are not
being investigated or monitored by the disciplining authority for substance abuse.
License holders voluntarily participating in the approved programs without
being referred by the disciplining authority shall not be subject to
disciplinary action under RCW 18.130.160 for their substance abuse, and shall
not have their participation made known to the disciplining authority, if they
meet the requirements of this section and the program in which they are
participating.
(3)
The license holder shall sign a waiver allowing the program to release
information to the disciplining authority if the licensee does not comply with
the requirements of this section or is unable to practice with reasonable skill
or safety. The substance abuse program shall report to the disciplining
authority any license holder who fails to comply with the requirements of this
section or the program or who, in the opinion of the program, is unable to
practice with reasonable skill or safety. License holders shall report to the
disciplining authority if they fail to comply with this section or do not
complete the program's requirements. License holders may, upon the agreement
of the program and disciplining authority, reenter the program if they have
previously failed to comply with this section.
(4)
The treatment and pretreatment records of license holders referred to or
voluntarily participating in approved programs shall be confidential, shall be
exempt from RCW 42.17.250 through 42.17.450, and shall not be subject to
discovery by subpoena or admissible as evidence except for monitoring records
reported to the disciplining authority for cause as defined in subsection (3)
of this section. Monitoring records relating to license holders referred to
the program by the disciplining authority or relating to license holders
reported to the disciplining authority by the program for cause, shall be
released to the disciplining authority at the request of the disciplining
authority. Records held by the disciplining authority under this section shall
be exempt from RCW 42.17.250 through 42.17.450 and shall not be subject to discovery
by subpoena except by the license holder.
(5)
"Substance abuse," as used in this section, means the impairment, as
determined by the disciplining authority, of a license holder's professional
services by an addiction to, a dependency on, or the use of alcohol, legend
drugs, or controlled substances.
(6)
This section does not affect an employer's right or ability to make
employment-related decisions regarding a license holder. This section does not
restrict the authority of the disciplining authority to take disciplinary
action for any other unprofessional conduct.
(7)
A person who, in good faith, reports information or takes action in connection
with this section is immune from civil liability for reporting information or
taking the action.
(a)
The immunity from civil liability provided by this section shall be liberally
construed to accomplish the purposes of this section and the persons entitled
to immunity shall include:
(i)
An approved monitoring treatment program;
(ii)
The professional association operating the program;
(iii)
Members, employees, or agents of the program or association;
(iv)
Persons reporting a license holder as being possibly impaired or
providing information about the license holder's impairment; and
(v)
Professionals supervising or monitoring the course of the impaired license
holder's treatment or rehabilitation.
(b)
The courts are strongly encouraged to impose sanctions on clients and their
attorneys whose allegations under this subsection are not made in good faith
and are without either reasonable objective, substantive grounds, or both.
(c)
The immunity provided in this section is in addition to any other immunity
provided by law.
Sec.
11. RCW
18.130.300 and 1994 sp.s. c 9 s 605 are each amended to read as follows:
(1)
The secretary, members of the boards or commissions, or individuals acting on
their behalf are immune from suit in any action, civil or criminal, based on
any disciplinary proceedings or other official acts performed in the course of
their duties.
(2)
A voluntary substance abuse monitoring program or an impaired practitioner
program approved by a disciplining authority, or individuals acting on their
behalf, are immune from suit in a civil action based on any disciplinary
proceedings or other official acts performed in the course of their duties.
NEW
SECTION. Sec. 12. A
new section is added to chapter 18.71 RCW to read as follows:
The
impaired physician account is created in the custody of the state treasurer.
All receipts from RCW 18.71.310 from license surcharges on physicians and physician
assistants shall be deposited into the account. Expenditures from the account
may only be used for the impaired physician program under this chapter. Only
the secretary of health or the secretary's designee may authorize expenditures
from the account. No appropriation is required for expenditures from this
account.
Sec.
13. RCW
18.57A.020 and 1996 c 191 s 39 are each amended to read as follows:
(1)
The board shall adopt rules fixing the qualifications and the educational and
training requirements for licensure as an osteopathic 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 and eligibility to take an examination
approved by the board, providing such examination tests subjects substantially
equivalent to the curriculum of an accredited physician assistant training
program.
(2)(a)
The board 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 training
course.
(b)
Such rules shall provide:
(i)
That the practice of an osteopathic physician assistant shall be limited to the
performance of those services for which he or she is trained; and
(ii)
That each osteopathic physician assistant shall practice osteopathic medicine
only under the supervision and control of an osteopathic physician licensed in
this state, but such supervision and control shall not be construed to
necessarily require the personal presence of the supervising physicians at the
place where services are rendered. The board may authorize the use of alternative
supervisors who are licensed either under chapter 18.57 or 18.71 RCW.
(3)
Applicants for licensure shall file an application with the board on a form
prepared by the secretary with the approval of the board, detailing the
education, training, and experience of the physician assistant and such other
information as the board may require. The application shall be accompanied by
a fee determined by the secretary as provided in RCW 43.70.250 and 43.70.280. A
surcharge of twenty-five dollars per year may be charged on each license
renewal or issuance of a new license to be collected by the department of
health for physician assistant participation in an impaired practitioner
program. Each applicant shall furnish proof satisfactory to the board of
the following:
(a)
That the applicant has completed an accredited physician assistant program
approved by the board and is eligible to take the examination approved by the
board;
(b)
That the applicant is of good moral character; and
(c)
That the applicant is physically and mentally capable of practicing osteopathic
medicine as an osteopathic physician assistant with reasonable skill and
safety. The board 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 as an osteopathic physician assistant.
(4) The board may approve, deny, or take other disciplinary action
upon the application for a license as provided in the uniform disciplinary act,
chapter 18.130 RCW. The license shall be renewed as determined under RCW
43.70.250 and 43.70.280.
Sec.
14. RCW
18.71A.020 and 1996 c 191 s 57 are each amended to read as follows:
(1)
The 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 commission and eligibility to take an examination approved by
the 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 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 commission on a
form prepared by the secretary with the approval of the commission, detailing
the education, training, and experience of the physician assistant and such
other information as the commission may require. The application shall be
accompanied by a fee determined by the secretary as provided in RCW 43.70.250
and 43.70.280. A surcharge of twenty-five dollars per year shall be charged
on each license renewal or issuance of a new license to be collected by the
department and deposited into the impaired physician account for physician
assistant participation in the impaired physician program. Each applicant
shall furnish proof satisfactory to the commission of the following:
(a)
That the applicant has completed an accredited physician assistant program
approved by the commission and is eligible to take the examination approved by
the 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 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 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 as determined under RCW 43.70.250 and
43.70.280. The commission may authorize the use of alternative supervisors who
are licensed either under chapter 18.57 or 18.71 RCW.
NEW
SECTION. Sec. 15. 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.
