BILL REQ. #:  H-1934.3 

READ FIRST TIME 02/26/07.   

     AN ACT Relating to health professions; amending RCW 18.130.050, 18.130.060, 18.130.080, 18.130.090, 18.130.170, 18.130.172, 18.130.310, 70.41.210, and 43.70.320; reenacting and amending RCW 18.130.160; adding new sections to chapter 18.130 RCW; adding a new section to chapter 42.52 RCW; creating new sections; prescribing penalties; providing an effective date; and declaring an emergency.

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

NEW SECTION.  Sec. 1   From statehood, Washington has constitutionally provided for the regulation of the practice of medicine and the sale of drugs and medicines. This constitutional recognition of the importance of regulating health care practitioners derives not from providers' financial interest in their license, but from the greater need to protect the public health and safety by assuring that the health care providers and medicines that society relies upon meet certain standards of quality.
     The legislature finds that the issuance of a license to practice as a health care provider should be a means to ensure quality and not be a means to ensure financial benefit for providers. Statutory and administrative requirements provide sufficient due process protections to prevent the unwarranted revocation of a health care provider's license. While those due process protections must be maintained, there is an urgent need to return to the original constitutional mandate that patients be ensured quality from their health care providers. The legislature has recognized and medical malpractice reforms have recognized the importance of quality and patient safety through such measures as a new adverse events reporting system. Reforms to the health care provider licensing system is another step toward improving quality in health care. Therefore, the legislature intends to increase the authority of those engaged in the regulation of health care providers to swiftly identify and remove health care providers who pose a risk to the public.

Sec. 2   RCW 18.130.050 and 2006 c 99 s 4 are each amended to read as follows:
     The disciplining authority has the following authority:
     (1) To adopt, amend, and rescind such rules as are deemed necessary to carry out this chapter;
     (2) To ((investigate)) use individual members of the boards and commissions to provide consultation and assistance with investigations of all complaints or reports of unprofessional conduct as defined in this chapter as requested by the secretary and to hold hearings as provided in this chapter. If the secretary determines that the complaint involves standards of practice or that clinical expertise is necessary, the secretary shall assure that the board or commission is actively involved in the investigation;
     (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)) consulting and assisting with the investigation of a complaint or report of unprofessional conduct, to conduct practice reviews as requested by the secretary;
     (7) ((To take emergency action ordering summary suspension of a license, or restriction or limitation of the license holder's practice pending proceedings by the disciplining authority. Consistent with RCW 18.130.370, a disciplining authority shall issue a summary suspension of the license or temporary practice permit of a license holder prohibited from practicing a health care profession in another state, federal, or foreign jurisdiction because of an act of unprofessional conduct that is substantially equivalent to an act of unprofessional conduct prohibited by this chapter or any of the chapters specified in RCW 18.130.040. The summary suspension remains in effect until proceedings by the Washington disciplining authority have been completed;
     (8))) To use a presiding officer as authorized in RCW 18.130.095(3) or the office of administrative hearings as authorized in chapter 34.12 RCW to conduct hearings. The disciplining authority shall make the final decision regarding disposition of the license unless the disciplining authority elects to delegate in writing the final decision to the presiding officer;
     (((9))) (8) To use individual members of the boards to ((direct)) provide consultation and assistance with investigations as requested by the secretary. However, the member of the board shall not subsequently participate in the hearing of the case;
     (((10))) (9) To enter into contracts for professional services determined to be necessary for adequate enforcement of this chapter;
     (((11))) (10) 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))) (11) To adopt standards of professional conduct or practice;
     (((13))) (12) 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. After January 1, 2008, all sanctions must be issued in accordance with section 10 of this act;
     (((14))) (13) To designate individuals authorized to sign subpoenas and statements of charges;
     (((15))) (14) 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))) (15) 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).

Sec. 3   RCW 18.130.060 and 2006 c 99 s 1 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. The secretary must, whenever practical, make primary assignments on a long-term basis to foster the development and maintenance of staff expertise. To ensure continuity and best practices, the secretary will regularly evaluate staff assignments and workload distribution;
     (2) Upon the request of a board or commission, to appoint pro tem members to participate as members of a panel of the board or commission in connection with proceedings specifically identified in the request. Individuals so appointed must meet the same minimum qualifications as regular members of the board or commission. Pro tem members appointed for matters under this chapter are appointed for a term of no more than one year. No pro tem member may serve more than four one-year terms. While serving as board or commission 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 or commission. The chairperson of a panel shall be a regular member of the board or commission appointed by the board or commission chairperson. Panels have authority to act as directed by the board or commission 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 or commission and within the authority of the board or commission. The authority to act through panels does not restrict the authority of the board or commission to act as a single body at any phase of proceedings within the board's or commission's jurisdiction. Board or commission panels may make interim orders and issue final decisions with respect to matters and cases delegated to the panel by the board or commission. 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)). The secretary may request the consultation and assistance of the appropriate disciplining authority, and where standards of practice or clinical expertise is necessary, the secretary shall assure that the board or commission is actively involved in the investigation;
     (5) To review results of investigations conducted under this chapter and determine the appropriate disposition, which may include closure, notice of correction, stipulations permitted by RCW 18.130.172, or issuance of a statement of charges;
     (6) To take emergency action ordering summary suspension of a license, or restriction or limitation of the license holder's practice pending proceedings by the disciplining authority. Consistent with RCW 18.130.370, the secretary shall issue a summary suspension of the license or temporary practice permit of a license holder prohibited from practicing a health care profession in another state, federal, or foreign jurisdiction because of an act of unprofessional conduct that is substantially equivalent to an act of unprofessional conduct prohibited by this chapter or any of the chapters specified in RCW 18.130.040. The summary suspension remains in effect until proceedings by the Washington disciplining authority have been completed;
     (7) To have the health professions regulatory program establish a system to recruit potential public members, to review the qualifications of such potential members, and to provide orientation to those public members appointed pursuant to law by the governor or the secretary to the boards and commissions specified in RCW 18.130.040(2)(b), and to the advisory committees and councils for professions specified in RCW 18.130.040(2)(a); and
     (((6))) (8) To adopt rules, in consultation with the disciplining authorities, requiring every license holder to report information identified in RCW 18.130.070.

NEW SECTION.  Sec. 4   A new section is added to chapter 18.130 RCW to read as follows:
     (1)(a) The department shall establish requirements for each applicant for an initial license to obtain a state background check through the state patrol prior to the issuance of any license. The background check may be fingerprint-based at the discretion of the department.
     (b) The department shall specify those situations where a background check under (a) of this subsection is inadequate and an applicant for an initial license must obtain an electronic fingerprint-based national background check through the state patrol and federal bureau of investigation. Situations where a background check is inadequate may include instances where an applicant has recently lived out-of-state or where the applicant has a criminal record in Washington. The secretary shall issue a temporary practice permit to an applicant who must have a national background check conducted if the background check conducted under (a) of this subsection does not reveal a criminal record in Washington, and if the applicant meets the provisions of RCW 18.130.075.
     (2) The department shall adopt rules to require license holders to report to the disciplining authority any arrests, convictions, or other determinations or findings by a law enforcement agency occurring after the effective date of this section for a criminal offense. The report must be made within fourteen days of the conviction.
     (3) The department shall conduct an annual review of a representative sample of all license holders who have previously obtained a background check through the department. The selection of the license holders to be reviewed shall be representative of all categories of license holders and geographic locations.
     (4)(a) When deciding whether or not to issue an initial license, the disciplining authority shall consider the results of any background check conducted pursuant to subsection (1) of this section that reveals a conviction for any criminal offense that constitutes unprofessional conduct under this chapter or the chapters specified in RCW 18.130.040(2) or a series of arrests that when considered together demonstrate a pattern of behavior that, without investigation, may pose a risk to the safety of the license holder's patients.
     (b) If the background check conducted pursuant to subsection (3) of this section reveals any information related to unprofessional conduct that has not been previously disclosed to the disciplining authority, it shall take appropriate disciplinary action against the license holder.
     (5) The department shall:
     (a) Require the applicant or license holder to submit full sets of fingerprints if necessary to complete the background check;
     (b) Require the applicant to submit any fees for background check activities conducted pursuant to subsection (1) of this section, except as precluded by RCW 43.70.110, and other information required by the state patrol;
     (c) Notify the applicant of the results of the background check. If any background check reveals a criminal record, the department shall send the applicant a copy of the record upon request; and
     (d) Restrict use of the background check results to determining the individual's suitability for a license and to conducting disciplinary functions.

Sec. 5   RCW 18.130.080 and 2006 c 99 s 5 are each amended to read as follows:
     (1) ((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,)) (a) An individual, an impaired practitioner program, or a voluntary substance abuse monitoring program approved by a disciplining authority, may submit a written complaint to the ((disciplining authority)) secretary charging a license holder or applicant with unprofessional conduct and specifying the grounds therefor or to report information to the ((disciplining authority)) secretary, 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.
     (b)(i) Every license holder, corporation, organization, health care facility, and state and local governmental agency that employs a license holder shall report to the secretary when any license holder's services have been terminated or restricted based upon a determination that the license holder has either committed an act or acts that may constitute unprofessional conduct or 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.
     (ii) All reports required by (b)(i) of this subsection must be submitted to the secretary as soon as possible, but no later than twenty days after a determination has been made. A report should contain the following information, if known:
     (A) The name, address, and telephone number of the person making the report;
     (B) The name, address, and telephone number of the license holder being reported;
     (C) The case number of any patient whose treatment is the subject of the report;
     (D) A brief description or summary of the facts that gave rise to the issuance of the report, including dates of occurrences;
     (E) If court action is involved, the name of the court in which the action is filed, the date of filing, and the docket number; and
     (F) Any further information that would aid in the evaluation of the report.
     (iii) Mandatory reports required by (b)(i) of this subsection are exempt from public inspection and copying to the extent permitted under chapter 42.56 RCW or to the extent that public inspection or copying of the report would invade or violate a person's right to privacy as set forth in RCW 42.56.050.
     (2) If the ((disciplining authority)) secretary determines that ((the)) a complaint submitted under subsection (1) of this section merits investigation, or if the ((disciplining authority)) secretary has reason to believe, without a formal complaint, that a license holder or applicant may have engaged in unprofessional conduct, the ((disciplining authority)) secretary shall investigate to determine whether there has been unprofessional conduct. In determining whether or not to investigate, the ((disciplining authority)) secretary shall consider any prior complaints received by the ((disciplining authority)) secretary, any prior findings of fact under RCW 18.130.110, any stipulations to informal disposition under RCW 18.130.172, and any comparable action taken by other state disciplining authorities.
     (((2))) (3) Notwithstanding subsection (((1))) (2) of this section, the ((disciplining authority)) secretary shall initiate an investigation in every instance where:
     (a) The ((disciplining authority)) secretary receives information that a health care provider has been disqualified from participating in the federal medicare program, under Title XVIII of the federal social security act, or the federal medicaid program, under Title XIX of the federal social security act; or
     (b) There is a pattern of complaints, arrests, or other actions that may not have resulted in a formal adjudication of wrongdoing, but when considered together demonstrate a pattern of similar conduct that, without investigation, may pose a risk to the safety of the license holder's patients.
     (4) Failure of an entity to submit a mandatory report to the secretary under subsection (1)(b) of this section is punishable by a civil penalty not to exceed five hundred dollars and constitutes unprofessional conduct.
     (5) If a report has been made by a hospital to the department under RCW 70.41.210, a report to the secretary under subsection (1)(b) of this section is not required.
     (((3) 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.)) (6) A person is immune from civil liability, whether direct or derivative, for providing information in good faith to the secretary under this section.

Sec. 6   RCW 18.130.090 and 1993 c 367 s 1 are each amended to read as follows:
     (1) If the ((disciplining authority)) secretary determines, upon investigation, that there is reason to believe a violation of RCW 18.130.180 has occurred, a statement of charge or charges shall be prepared and served upon the license holder or applicant at the earliest practical time. The statement of charge or charges shall be accompanied by a notice that the license holder or applicant may request a hearing to contest the charge or charges. The license holder or applicant must file a request for hearing with the disciplining authority within twenty days after being served the statement of charges. If the twenty-day limit results in a hardship upon the license holder or applicant, he or she may request for good cause an extension not to exceed sixty additional days. If the disciplining authority finds that there is good cause, it shall grant the extension. The failure to request a hearing constitutes a default, whereupon the disciplining authority may enter a decision on the basis of the facts available to it.
     (2) If a hearing is requested, the time of the hearing shall be fixed by the disciplining authority as soon as convenient, but the hearing shall not be held earlier than thirty days after service of the charges upon the license holder or applicant.

Sec. 7   RCW 18.130.160 and 2006 c 99 s 6 and 2006 c 8 s 104 are each reenacted and amended to read as follows:
     Upon a finding, after hearing, that a license holder or applicant has committed unprofessional conduct or is unable to practice with reasonable skill and safety due to a physical or mental condition, the disciplining authority ((may consider the imposition of sanctions, taking into account)) shall issue an order including sanctions adopted in accordance with the schedule adopted under section 10 of this act giving proper consideration to any prior findings of fact under RCW 18.130.110, any stipulations to informal disposition under RCW 18.130.172, and any action taken by other in-state or out-of-state disciplining authorities((, and issue an)). The order ((providing)) must provide for one or any combination of the following, as directed by the schedule:
     (1) Revocation of the license;
     (2) Suspension of the license for a fixed or indefinite term;
     (3) Restriction or limitation of the practice;
     (4) Requiring the satisfactory completion of a specific program of remedial education or treatment;
     (5) The monitoring of the practice by a supervisor approved by the disciplining authority;
     (6) Censure or reprimand;
     (7) Compliance with conditions of probation for a designated period of time;
     (8) Payment of a fine for each violation of this chapter, not to exceed five thousand dollars per violation. Funds received shall be placed in the health professions account;
     (9) Denial of the license request;
     (10) Corrective action;
     (11) Refund of fees billed to and collected from the consumer;
     (12) A surrender of the practitioner's license in lieu of other sanctions, which must be reported to the federal data bank.
     Any of the actions under this section may be totally or partly stayed by the disciplining authority. Safeguarding the public's health and safety is the paramount responsibility of every disciplining authority ((and)). In determining what action is appropriate, the disciplining authority must consider the schedule adopted under section 10 of this act. Where the schedule allows flexibility in determining the appropriate sanction, the disciplining authority must first consider what sanctions are necessary to protect or compensate the public. Only after such provisions have been made may the disciplining authority consider and include in the order requirements designed to rehabilitate the license holder or applicant. All costs associated with compliance with orders issued under this section are the obligation of the license holder or applicant.
     The disciplining authority may determine that a case presents unique circumstances that the schedule adopted under section 10 of this act does not adequately address. The disciplining authority may deviate from the schedule adopted under section 10 of this act when selecting appropriate sanctions, but the disciplining authority must issue a written explanation of the basis for not following the schedule.
     The ((licensee)) license holder or applicant may enter into a stipulated disposition of charges that includes one or more of the sanctions of this section, but only after a statement of charges has been issued and the ((licensee)) license holder has been afforded the opportunity for a hearing and has elected on the record to forego such a hearing. The stipulation shall either contain one or more specific findings of unprofessional conduct or inability to practice, or a statement by the ((licensee)) license holder acknowledging that evidence is sufficient to justify one or more specified findings of unprofessional conduct or inability to practice. The stipulation entered into pursuant to this subsection shall be considered formal disciplinary action for all purposes.

Sec. 8   RCW 18.130.170 and 1995 c 336 s 8 are each amended to read as follows:
     (1) If the ((disciplining authority)) secretary believes a license holder or applicant may be unable to practice with reasonable skill and safety to consumers by reason of any mental or physical condition, a statement of charges in the name of the ((disciplining authority)) secretary shall be served on the license holder or applicant and notice shall also be issued providing an opportunity for a hearing. The hearing shall be limited to the sole issue of the capacity of the license holder or applicant to practice with reasonable skill and safety. If the disciplining authority determines that the license holder or applicant is unable to practice with reasonable skill and safety for one of the reasons stated in this subsection, the disciplining authority shall impose such sanctions under RCW 18.130.160 as is deemed necessary to protect the public.
     (2)(a) In investigating or adjudicating a complaint or report that a license holder or applicant may be unable to practice with reasonable skill or safety by reason of any mental or physical condition, the ((disciplining authority)) secretary may require a license holder or applicant to submit to a mental or physical examination by one or more licensed or certified health professionals designated by the ((disciplining authority)) secretary. The license holder or applicant shall be provided written notice of the ((disciplining authority's)) secretary's intent to order a mental or physical examination, which notice shall include: (i) A statement of the specific conduct, event, or circumstances justifying an examination; (ii) a summary of the evidence supporting the ((disciplining authority's)) secretary's concern that the license holder or applicant may be unable to practice with reasonable skill and safety by reason of a mental or physical condition, and the grounds for believing such evidence to be credible and reliable; (iii) a statement of the nature, purpose, scope, and content of the intended examination; (iv) a statement that the license holder or applicant has the right to respond in writing within twenty days to challenge the ((disciplining authority's)) secretary's grounds for ordering an examination or to challenge the manner or form of the examination; and (v) a statement that if the license holder or applicant timely responds to the notice of intent, then the license holder or applicant will not be required to submit to the examination while the response is under consideration.
     (b) Upon submission of a timely response to the notice of intent to order a mental or physical examination, the license holder or applicant shall have an opportunity to respond to or refute such an order by submission of evidence or written argument or both. The evidence and written argument supporting and opposing the mental or physical examination shall be reviewed by either a panel of the disciplining authority members who have not been involved with the allegations against the license holder or applicant or a neutral decision maker approved by the disciplining authority. The reviewing panel of the disciplining authority or the approved neutral decision maker may, in its discretion, ask for oral argument from the parties. The reviewing panel of the disciplining authority or the approved neutral decision maker shall prepare a written decision as to whether: There is reasonable cause to believe that the license holder or applicant may be unable to practice with reasonable skill and safety by reason of a mental or physical condition, or the manner or form of the mental or physical examination is appropriate, or both.
     (c) Upon receipt by the ((disciplining authority)) secretary of the written decision, or upon the failure of the license holder or applicant to timely respond to the notice of intent, the ((disciplining authority)) secretary may issue an order requiring the license holder or applicant to undergo a mental or physical examination. All such mental or physical examinations shall be narrowly tailored to address only the alleged mental or physical condition and the ability of the license holder or applicant to practice with reasonable skill and safety. An order of the ((disciplining authority)) secretary requiring the license holder or applicant to undergo a mental or physical examination is not a final order for purposes of appeal. The cost of the examinations ordered by the ((disciplining authority)) secretary shall be paid out of the health professions account. In addition to any examinations ordered by the ((disciplining authority)) secretary, the ((licensee)) license holder may submit physical or mental examination reports from licensed or certified health professionals of the license holder's or applicant's choosing and expense.
     (d) If the disciplining authority finds that a license holder or applicant has failed to submit to a properly ordered mental or physical examination, then the disciplining authority may order appropriate action or discipline under RCW 18.130.180(9), unless the failure was due to circumstances beyond the person's control. However, no such action or discipline may be imposed unless the license holder or applicant has had the notice and opportunity to challenge the ((disciplining authority's)) secretary's grounds for ordering the examination, to challenge the manner and form, to assert any other defenses, and to have such challenges or defenses considered by either a panel of the disciplining authority members who have not been involved with the allegations against the license holder or applicant or a neutral decision maker approved by the disciplining authority, as previously set forth in this section. Further, the action or discipline ordered by the disciplining authority shall not be more severe than a suspension of the license, certification, registration or application until such time as the license holder or applicant complies with the properly ordered mental or physical examination.
     (e) Nothing in this section shall restrict the power of ((a disciplining authority)) the secretary to act in an emergency under RCW 34.05.422(4), 34.05.479, and ((18.130.050(7))) 18.130.060(6).
     (f) A determination by a court of competent jurisdiction that a license holder or applicant is mentally incompetent or ((mentally ill)) an individual with mental illness is presumptive evidence of the license holder's or applicant's inability to practice with reasonable skill and safety. An individual affected under this section shall at reasonable intervals be afforded an opportunity, at his or her expense, to demonstrate that the individual can resume competent practice with reasonable skill and safety to the consumer.
     (3) For the purpose of subsection (2) of this section, an applicant or license holder governed by this chapter, by making application, practicing, or filing a license renewal, is deemed to have given consent to submit to a mental, physical, or psychological examination when directed in writing by the ((disciplining authority)) secretary and further to have waived all objections to the admissibility or use of the examining health professional's testimony or examination reports by the ((disciplining authority)) secretary on the ground that the testimony or reports constitute privileged communications.

Sec. 9   RCW 18.130.172 and 2000 c 171 s 29 are each amended to read as follows:
     (1) Prior to serving a statement of charges under RCW 18.130.090 or 18.130.170, the ((disciplinary authority)) secretary may furnish a statement of allegations to the licensee or applicant along with a detailed summary of the evidence relied upon to establish the allegations and a proposed stipulation for informal resolution of the allegations. These documents shall be exempt from public disclosure until such time as the allegations are resolved either by stipulation or otherwise.
     (2) The ((disciplinary)) disciplining authority and the applicant or licensee may stipulate that the allegations may be disposed of informally in accordance with this subsection. The stipulation shall contain a statement of the facts leading to the filing of the complaint; the act or acts of unprofessional conduct alleged to have been committed or the alleged basis for determining that the applicant or licensee is unable to practice with reasonable skill and safety; a statement that the stipulation is not to be construed as a finding of either unprofessional conduct or inability to practice; an acknowledgement that a finding of unprofessional conduct or inability to practice, if proven, constitutes grounds for discipline under this chapter; and an agreement on the part of the licensee or applicant that the sanctions set forth in RCW 18.130.160, except RCW 18.130.160 (1), (2), (6), and (8), may be imposed as part of the stipulation, except that no fine may be imposed but the licensee or applicant may agree to reimburse the ((disciplinary authority)) secretary the costs of investigation and processing the complaint up to an amount not exceeding one thousand dollars per allegation; and an agreement on the part of the ((disciplinary)) disciplining authority to forego further disciplinary proceedings concerning the allegations. A stipulation entered into pursuant to this subsection shall not be considered formal disciplinary action.
     (3) If the licensee or applicant declines to agree to disposition of the charges by means of a stipulation pursuant to subsection (2) of this section, the ((disciplinary authority)) secretary may proceed to formal disciplinary action pursuant to RCW 18.130.090 or 18.130.170.
     (4) Upon execution of a stipulation under subsection (2) of this section by both the licensee or applicant and the ((disciplinary)) disciplining authority, the complaint is deemed disposed of and shall become subject to public disclosure on the same basis and to the same extent as other records of the ((disciplinary)) disciplining authority. Should the licensee or applicant fail to pay any agreed reimbursement within thirty days of the date specified in the stipulation for payment, the ((disciplinary authority)) secretary may seek collection of the amount agreed to be paid in the same manner as enforcement of a fine under RCW 18.130.165.

NEW SECTION.  Sec. 10   A new section is added to chapter 18.130 RCW to read as follows:
     (1) The disciplining authorities identified in RCW 18.130.040(2)(b) shall review the secretary's sanctioning guidelines and shall collaborate to develop a schedule that defines appropriate ranges of sanctions that are applicable upon a determination that a license holder has committed unprofessional conduct as defined in this chapter or the chapters specified in RCW 18.130.040(2). The schedule must identify aggravating and mitigating circumstances that may enhance or reduce the sanction imposed by the disciplining authority for unprofessional conduct. The schedule must apply to all disciplining authorities. In addition, the disciplining authorities shall make provisions for instances in which there are multiple findings of unprofessional conduct. When establishing the proposed schedule, the disciplining authorities shall consider maintaining consistent sanction determinations that maximize the protection of the public's health and while maintaining the rights of health care providers of the different health professions. The disciplining authorities shall submit the proposed schedule and recommendations to modify or adopt the secretary's guidelines to the secretary no later than November 15, 2007.
     (2) The secretary shall adopt rules establishing a uniform sanction schedule to be applied to all disciplinary actions commenced under this chapter after January 1, 2008. The secretary shall review the proposed schedule developed in accordance with subsection (1) of this section and may modify the schedule as necessary to provide greater protection to the public. The secretary shall use his or her emergency rule-making authority pursuant to the procedures under chapter 34.05 RCW, to adopt rules that take effect no later than January 1, 2008, to implement the schedule.
     (3) The disciplining authority may determine that a case presents unique circumstances that the schedule adopted under this section does not adequately address. The disciplining authority may deviate from the schedule adopted under this section when selecting appropriate sanctions, but the disciplining authority must issue a written explanation in the order of the basis for not following the schedule.
     (4) The secretary shall report to the legislature by January 15, 2008, on the sanctioning schedule adopted.

Sec. 11   RCW 18.130.310 and 1989 1st ex.s. c 9 s 313 are each amended to read as follows:
     (1) Subject to RCW 40.07.040, the disciplinary authority shall submit ((a biennial)) an annual report to the legislature on its proceedings during the ((biennium)) year, detailing the number of complaints made, investigated, and adjudicated and manner of disposition. In addition, the report must provide data on the department's background check activities conducted under section 4 of this act and the effectiveness of those activities in identifying potential license holders who may not be qualified to practice safely. The report may include recommendations for improving the disciplinary process, including proposed legislation. The department shall develop a uniform report format.
     (2) Each health profession board and commission identified in RCW 18.130.040(2)(b) shall submit an annual report to complement the report required under subsection (1) of this section. Each report must identify the disciplinary activities of the individual board or commission, rule-making and policy activities, and receipts and expenditures for the profession.

NEW SECTION.  Sec. 12   A new section is added to chapter 18.130 RCW to read as follows:
     To implement section 4 of this act, the department may increase application and renewal fees by amounts that exceed the fiscal growth factor under RCW 43.135.055.

Sec. 13   RCW 70.41.210 and 2005 c 470 s 1 are each amended to read as follows:
     (1) The chief administrator or executive officer of a hospital shall report to the department when the practice of a health care practitioner as defined in subsection (2) of this section is restricted, suspended, limited, or terminated based upon a conviction, determination, or finding by the hospital that the health care practitioner has committed an action defined as unprofessional conduct under RCW 18.130.180. The chief administrator or executive officer shall also report any voluntary restriction or termination of the practice of a health care practitioner as defined in subsection (2) of this section while the practitioner is under investigation or the subject of a proceeding by the hospital regarding unprofessional conduct, or in return for the hospital not conducting such an investigation or proceeding or not taking action. The department will forward the report to the appropriate disciplining authority.
     (2) The reporting requirements apply to the following health care practitioners: Pharmacists as defined in chapter 18.64 RCW; advanced registered nurse practitioners as defined in chapter 18.79 RCW; dentists as defined in chapter 18.32 RCW; naturopaths as defined in chapter 18.36A RCW; optometrists as defined in chapter 18.53 RCW; osteopathic physicians and surgeons as defined in chapter 18.57 RCW; osteopathic ((physician [physicians'])) physicians' assistants as defined in chapter 18.57A RCW; physicians as defined in chapter 18.71 RCW; physician assistants as defined in chapter 18.71A RCW; podiatric physicians and surgeons as defined in chapter 18.22 RCW; and psychologists as defined in chapter 18.83 RCW.
     (3) Reports made under subsection (1) of this section shall be made within fifteen days of the date: (a) A conviction, determination, or finding is made by the hospital that the health care practitioner has committed an action defined as unprofessional conduct under RCW 18.130.180; or (b) the voluntary restriction or termination of the practice of a health care practitioner, including his or her voluntary resignation, while under investigation or the subject of proceedings regarding unprofessional conduct under RCW 18.130.180 is accepted by the hospital.
     (4) Failure of a hospital to comply with this section is punishable by a civil penalty not to exceed ((two)) five hundred ((fifty)) dollars.
     (5) A hospital, its chief administrator, or its executive officer who files a report under this section is immune from suit, whether direct or derivative, in any civil action related to the filing or contents of the report, unless the conviction, determination, or finding on which the report and its content are based is proven to not have been made in good faith. The prevailing party in any action brought alleging the conviction, determination, finding, or report was not made in good faith, shall be entitled to recover the costs of litigation, including reasonable attorneys' fees.
     (6) The department shall forward reports made under subsection (1) of this section to the appropriate disciplining authority designated under Title 18 RCW within fifteen days of the date the report is received by the department. The department shall notify a hospital that has made a report under subsection (1) of this section of the results of the disciplining authority's case disposition decision within fifteen days after the case disposition. Case disposition is the decision whether to issue a statement of charges, take informal action, or close the complaint without action against a practitioner. In its biennial report to the legislature under RCW 18.130.310, the department shall specifically identify the case dispositions of reports made by hospitals under subsection (1) of this section.
     (7) The department shall not increase hospital license fees to carry out this section before July 1, 2007.

NEW SECTION.  Sec. 14   A new section is added to chapter 18.130 RCW to read as follows:
     Any license holder performing a gynecological examination or procedure must ensure that a third party is in the room where the examination or procedure is being conducted, unless the patient signs a written waiver of the right while the patient is competent to sign such a waiver.

NEW SECTION.  Sec. 15   (1) The Washington state medical quality assurance commission shall conduct a clinical competency examination pilot project. The project must:
     (a) Be developed in consultation with the University of Washington school of medicine;
     (b) Establish the skills to be examined and measurement standards and methods by which clinical competency is assessed; and
     (c) Include criteria for determining when a clinical competency examination may be required, including whether requiring the examination will assist the Washington state medical quality assurance commission in carrying out its duties, protecting the public, or promoting quality assurance within the profession.
     (2)(a) By December 1, 2007, the Washington state medical quality assurance commission shall submit an interim report to the appropriate committees of the legislature on the commission's progress in developing clinical competency examinations and its plans for implementation.
     (b) By December 1, 2009, the Washington state medical quality assurance commission shall submit a final report to the appropriate committees of the legislature on the effectiveness of the clinical competency examinations at identifying potentially harmful physicians and its ability to avoid harm to the public through remedial measures or other risk avoidance measures. The report must include data regarding the types of procedures most frequently subject to the program and the methods for identifying physicians in need of the program. The report must also include recommendations as to whether the program should be permanently implemented and whether the program should be expanded to other professions and any considerations for expanding the program.

NEW SECTION.  Sec. 16   A new section is added to chapter 42.52 RCW to read as follows:
     Members of a health profession board or commission as identified in RCW 18.130.040(2)(b) may express their professional opinions to an elected official about the work of the board or commission on which the member serves, even if those opinions differ from the department of health's official position. Such communication shall be to inform the elected official and not to lobby in support or opposition to any initiative to the legislature.

Sec. 17   RCW 43.70.320 and 1993 c 492 s 411 are each amended to read as follows:
     (1) There is created in the state treasury an account to be known as the health professions account. All fees received by the department for health professions licenses, registration, certifications, renewals, or examinations and the civil penalties assessed and collected by the department under RCW 18.130.190 shall be forwarded to the state treasurer who shall credit such moneys to the health professions account.
     (2) All expenses incurred in carrying out the health professions licensing activities of the department shall be paid from the account as authorized by legislative appropriation, except as provided in subsection (4) of this section. Any residue in the account shall be accumulated and shall not revert to the general fund at the end of the biennium.
     (3) The secretary shall biennially prepare a budget request based on the anticipated costs of administering the health professions licensing activities of the department which shall include the estimated income from health professions fees.
     (4) The secretary may spend unappropriated funds in the health professions account to meet unanticipated costs when revenues exceed more than fifteen percent over the department's estimated six-year spending projections. Unanticipated costs shall be limited to spending as authorized in subsection (3) of this section for anticipated costs.

NEW SECTION.  Sec. 18   Except for section 4 of this act, which takes effect January 1, 2008, this act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and takes effect immediately.