BILL REQ. #:  S-4166.1 

Read first time 01/17/08.   Referred to Committee on Health & Long-Term Care.

     AN ACT Relating to the medical disciplinary act; amending RCW 18.71.002, 18.71.003, 18.71.010, 18.71.015, 18.71.017, 18.71.017, 18.71.019, 18.71.0191, 18.71.0195, 18.71.0195, 18.71.030, 18.71.040, 18.71.050, 18.71.051, 18.71.055, 18.71.060, 18.71.070, 18.71.080, 18.71.085, 18.71.090, 18.71.095, 18.71.230, 18.71.300, 18.71.310, 18.71.315, 18.71.320, 18.71.330, 18.71.350, 18.71A.010, 18.71A.020, 18.71A.025, 18.71A.030, 18.71A.050, 18.71A.085, 18.50.115, 69.45.010, 69.50.402, 69.51A.010, 69.51A.070, 70.41.200, 70.41.230, 74.09.290, and 74.42.230; reenacting and amending RCW 18.71.205, 18.71A.040, 18.130.040, 18.130.040, 69.41.030, and 70.41.200; adding new sections to chapter 18.71 RCW; adding a new chapter to Title 18 RCW; creating new sections; repealing RCW 18.71.401 and 18.71.420; prescribing penalties; providing effective dates; providing expiration dates.

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

NEW SECTION.  Sec. 1   Since statehood, Washington's Constitution has provided for the regulation of the practice of medicine and the sale of drugs and medicines. This constitutional provision reflects the importance of regulating health care practitioners and the need to protect public health and safety.
     The legislature finds that the effective and efficient operation of a medical disciplining authority to perform mandated duties and protect the health, safety, and welfare of Washington's citizens is paramount.
     A disciplining authority must be accountable to the citizens of this state, the governor, and the legislature. In order to be accountable, a medical disciplining authority must have the authority to determine and implement policy within the law; set goals and objectives; and manage its affairs.
     The legislature intends to implement nationally recognized recommendations and best practices for medical regulation, including establishing an independent medical disciplining authority with control over its fiscal and staff resources.

Sec. 101   RCW 18.71.002 and 1994 sp.s. c 9 s 301 are each amended to read as follows:
     It is the purpose of the medical ((quality assurance commission)) board for safety and quality to ((regulate)) protect the public health through regulating the competency and quality of ((professional health care providers)) physicians and physician assistants under its jurisdiction by establishing, monitoring, and enforcing qualifications for licensing, consistent standards of practice, continuing competency mechanisms and quality care improvement programs, and ((discipline)) an efficient and fair disciplinary process. Rules, policies, and procedures developed by the ((commission)) board must promote the delivery of quality health care to the residents of the state of Washington.

Sec. 102   RCW 18.71.003 and 1955 c 202 s 1 are each amended to read as follows:
     This chapter is passed:
     (1) In the exercise of the police power of the state to protect public health, to promote the welfare of the state, and to provide an adequate public agency to act as a disciplinary body for the members of the medical profession licensed to practice medicine and surgery in this state;
     (2) Because the health and well-being of the people of this state are of paramount importance;
     (3) Because the relationship between the people of this state and the members of the medical profession licensed to practice medicine and surgery in this state is of such a unique and personal nature;
     (4) Because the conduct of members of the medical profession licensed to practice medicine and surgery in this state plays a vital role in preserving the health and well-being of the people of the state; ((and
     (4))) (5) Because the ((agency which now exists to handle disciplinary proceedings for members of the medical profession licensed to practice medicine and surgery in this state is ineffective and very infrequently employed, and consequently there is no effective means of handling such disciplinary proceedings when they are necessary for the protection of the public health)) public expects greater accountability of the members of the medical profession to whom they entrust their care when they are most vulnerable; and
     (6) Because experience around the country has found that an independent medical board, with control over its own budget and staff, is the most effective and safe way of licensing and disciplining medical professionals, and ensuring delivery of the highest quality medical care possible.

Sec. 103   RCW 18.71.010 and 1994 sp.s. c 9 s 302 are each amended to read as follows:
     The following terms used in this chapter shall have the meanings set forth in this section unless the context clearly indicates otherwise:
     (1) (("Commission")) "Board" means the Washington state medical ((quality assurance commission)) board for safety and quality.
     (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))) (3) "Emergency medical care" or "emergency medical service" has the same meaning as in chapter 18.73 RCW.

Sec. 104   RCW 18.71.015 and 2006 c 8 s 103 are each amended to read as follows:
     The Washington state medical ((quality assurance commission)) board for safety and quality 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 six individuals who are members of the public. At least two of the public members shall not be from the health care industry. Each congressional district now existing or hereafter created in the state must be represented by at least one physician member of the ((commission)) board. The terms of office of members of the ((commission)) board are not affected by changes in congressional district boundaries. Public members of the ((commission)) board 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)) board, or have a material or financial interest in the rendering of health services regulated by the ((commission)) board.
     The members of the ((commission)) board shall be appointed by the governor. Members of the initial ((commission)) board 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)) board, 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 336, chapter 9, Laws of 1994 sp. sess.)) medical quality assurance commission be appointed to the ((commission)) board. No member may serve more than two consecutive full terms. Each member shall hold office until a successor is appointed.
     Each member of the ((commission)) board 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 ((commission)) board shall meet as soon as practicable after appointment and elect officers each year. Meetings shall be held at least four times a year and at such place as the ((commission)) board determines and at such other times and places as the ((commission)) board deems necessary. A majority of the ((commission)) board members appointed and serving constitutes a quorum for the transaction of ((commission)) board business.
     The affirmative vote of a majority of a quorum of the ((commission)) board is required to carry any motion or resolution, to adopt any rule, or to pass any measure. The ((commission)) board 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 a quorum of the panel is required to transact business delegated to it by the ((commission)) board.
     Each member of the ((commission)) board shall be compensated in accordance with RCW 43.03.265 and in addition thereto shall be reimbursed for travel expenses incurred in carrying out the duties of the ((commission)) board 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)) in the medical professions account.
     Whenever the governor is satisfied that a member of ((a commission)) the board 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 ((commission)) board shall be filled for the unexpired term by appointment by the governor.
     The members of the ((commission)) board 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)) board.
     Members of the board prevailing upon the good faith defense provided for in this section are entitled to recover expenses and reasonable attorneys' fees incurred in establishing the defense.
     Whenever the workload of the ((commission)) board requires, the ((commission)) board may request that the ((secretary)) governor appoint pro tempore members of the ((commission)) board. When serving, pro tempore members of the ((commission)) board 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)) board.

Sec. 105   RCW 18.71.017 and 2000 c 171 s 23 are each amended to read as follows:
     (1) The ((commission)) board may adopt such rules and guidelines 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)) board is the successor in interest of the ((board of medical examiners and the medical disciplinary board)) medical quality assurance commission. All contracts, undertakings, agreements, rules, regulations, and policies continue in full force and effect on ((July 1, 1994)) the effective date of this section, unless otherwise repealed or rejected by this chapter or by the ((commission)) board.
     (2) The board may adopt rules governing the administration of sedation and anesthesia in the offices of persons licensed under this chapter, including necessary training and equipment.
     (3) The board shall adopt sanctioning guidelines.
     (4) The board shall adopt policies or programs on the following:
     (a) Public education regarding filing of complaints;
     (b) Compliance program to ensure license holders who have been disciplined comply with the terms of their sanctions;
     (c) Oversight program to ensure that the credentialing and the regulatory processes are performing as intended;
     (d) Annual review process of the board's information system to ensure that it effectively and efficiently assists in the areas of licensure, consumer complaints, and disciplinary action and monitoring; and
     (e) A disaster recovery and business continuity plan.

Sec. 106   RCW 18.71.017 and 2007 c 273 s 26 are each amended to read as follows:
     (1) The ((commission)) board may adopt such rules and guidelines 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)) board is the successor in interest of the ((board of medical examiners and the medical disciplinary board)) medical quality assurance commission. All contracts, undertakings, agreements, rules, regulations, and policies continue in full force and effect on ((July 1, 1994)) the effective date of this section, unless otherwise repealed or rejected by this chapter or by the ((commission)) board.
     (2) The ((commission)) board may adopt rules governing the administration of sedation and anesthesia in the offices of persons licensed under this chapter, including necessary training and equipment.
     (3) The board shall adopt sanctioning guidelines.
     (4) The board shall adopt policies or programs on the following:
     (a) Public education regarding filing of complaints;
     (b) Compliance program to ensure license holders who have been disciplined comply with the terms of their sanctions;
     (c) Oversight program to ensure that the credentialing and the regulatory processes are performing as intended;
     (d) Annual review process of the board's information system to ensure that it effectively and efficiently assists in the areas of licensure, consumer complaints, and disciplinary action and monitoring; and
     (e) A disaster recovery and business continuity plan.

Sec. 107   RCW 18.71.019 and 1996 c 195 s 1 are each amended to read as follows:
     The ((Uniform)) medical disciplinary act, chapter ((18.130 RCW)) 18.-- RCW (sections 201 through 246 of this act), governs unlicensed practice and the issuance and denial of licenses and discipline of licensees under this chapter. ((When a panel of the commission revokes a license, the respondent may request review of the revocation order of the panel by the remaining members of the commission not involved in the initial investigation. The respondent's request for review must be filed within twenty days of the effective date of the order revoking the respondent's license. The review shall be scheduled for hearing by the remaining members of the commission not involved in the initial investigation within sixty days. The commission shall adopt rules establishing review procedures.))

Sec. 108   RCW 18.71.0191 and 1994 sp.s. c 9 s 326 are each amended to read as follows:
     (1) The ((secretary of the department of health)) governor shall appoint, from a list of three names supplied by the ((commission)) board, an executive director who shall act to carry out the provisions of this chapter. The board may list the names in order of board preference. The ((secretary)) executive director may be removed by either the governor or the board.
     (2) The compensation of the executive director shall be set by the board. The executive director is exempt from the provisions of the civil service law, chapter 41.06 RCW, as now or hereafter amended.
     (3) The executive director at the direction of the board shall ((also employ such additional staff)):
     (a) Employ, evaluate, dismiss, discipline, and direct all professional, clerical, technical, investigative and administrative personnel necessary to carry on the work of the board, including ((administrative assistants,)) attorneys and investigators((, and clerical staff as are required to enable the commission to accomplish its duties and responsibilities. The executive director is exempt from the provisions of the civil service law, chapter 41.06 RCW, as now or hereafter amended));
     (b) Prepare the annual budget for approval by the board;
     (c) Appoint and employ medical consultants and agents necessary to conduct investigations, gather information, and perform those duties the executive director determines are necessary and appropriate to enforce this chapter;
     (d) Manage the board's offices;
     (e) Authorize expenditures from the medical professions account;
     (f) Perform any and all other duties assigned to the executive director by the board.

Sec. 109   RCW 18.71.0195 and 2005 c 274 s 227 are each amended to read as follows:
     (1) The contents of any report filed under ((RCW 18.130.070)) section 209 of this act shall be confidential and exempt from public disclosure pursuant to chapter 42.56 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)) board, or investigator thereof, who has been assigned to review the activities of a licensed physician.
     Upon a determination that a report is without merit, the ((commission's)) board's records may be purged of information relating to the report.
     (2) Every individual, medical association, medical society, hospital, ((medical service bureau)) health service contractor, health insurance carrier or agent, professional liability insurance carrier, professional standards review organization, agency of the federal, state, or local government, 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)) board under ((RCW 18.130.070)) section 209 of this act, 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. 110   RCW 18.71.0195 and 2007 c 273 s 24 are each amended to read as follows:
     (1) The contents of any report filed under ((RCW 18.130.070)) section 209 of this act shall be confidential and exempt from public disclosure pursuant to chapter 42.56 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)) board, or investigator thereof, who has been assigned to review the activities of a licensed physician.
     Upon a determination that a report is without merit, the ((commission's)) board's records may be purged of information relating to the report.
     (2) Every individual, medical association, medical society, hospital, ambulatory surgical facility, ((medical service bureau)) health service contractor, health insurance carrier or agent, professional liability insurance carrier, professional standards review organization, agency of the federal, state, or local government, 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)) board under ((RCW 18.130.070)) section 209 of this act, 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. 111   RCW 18.71.030 and 1996 c 178 s 4 are each 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, osteopathic medicine and surgery, nursing, chiropractic, 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 ((commission)) board, however, the performance of such services be only pursuant to a regular course of instruction or assignments from his or her instructor, or that such services are performed only under the supervision and control of a person licensed pursuant to this chapter;
     (8) The practice of medicine by a person serving a period of postgraduate medical training in a program of clinical medical training sponsored by a college or university in this state or by a hospital accredited in this state, however, the performance of such services shall be only pursuant to his or her duties as a trainee;
     (9) The practice of medicine by a person who is regularly enrolled in a physician assistant program approved by the ((commission)) board, however, the performance of such services 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 ((commission)) board, 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 ((commission)) board has jurisdiction to discipline a dentist practicing under this exemption and enjoin or suspend such dentist from the practice of nondental anesthesia according to this chapter and chapter ((18.130 RCW)) 18.-- RCW (sections 201 through 246 of this act);
     (13) Emergency lifesaving service rendered by a physician's trained emergency medical service intermediate life support technician and 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 18.79.290 and 28A.210.280.

Sec. 112   RCW 18.71.040 and 2003 c 275 s 1 are each amended to read as follows:
     The physicians and physician assistants of the state of Washington are responsible for all costs associated with the licensing, regulation, and discipline, pursuant to the medical disciplinary act, chapter 18.-- RCW (sections 201 through 246 of this act), of the medical profession. Every applicant for a license to practice medicine and surgery shall pay a fee determined by the ((secretary as provided in RCW 43.70.250)) board to cover such costs. The board shall from time to time establish the amount of all application fees, license fees, registration fees, examination fees, permit fees, renewal fees, and any other fees associated with the licensing, regulation, or discipline of the profession. In fixing the fees, the board shall set the fees at a sufficient level to defray the costs of administering the board pursuant to this act and the board's obligations pursuant to the medical disciplinary act. All such fees shall be fixed by rule adopted by the board in accordance with the provisions of the administrative procedure act, chapter 34.05 RCW.

Sec. 113   RCW 18.71.050 and 1994 sp.s. c 9 s 307 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 ((commission)) board on a form prepared and approved by the ((secretary with the approval of the commission)) board. Each applicant shall furnish proof satisfactory to the ((commission)) board of the following:
     (a) That the applicant has attended and graduated from a school of medicine approved by the ((commission)) board;
     (b) That the applicant has completed ((two)) three years of postgraduate medical training in a program acceptable to the ((commission)) board, provided that applicants graduating before July 28, 1985, may complete only one year of postgraduate medical training;
     (c) That the applicant is of good moral character; and
     (d) That the applicant is physically and mentally capable of safely carrying on the practice of medicine. The ((commission)) 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 and competently practice medicine. The costs of such examination or examinations shall be paid by the applicant.
     (2) Nothing in this section shall be construed as prohibiting the ((commission)) board from requiring such additional information from applicants as it deems necessary. The issuance and denial of licenses are subject to chapter ((18.130 RCW)) 18.-- RCW (sections 201 through 246 of this act), the ((Uniform)) medical disciplinary act.

Sec. 114   RCW 18.71.051 and 1994 sp.s. c 9 s 308 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 ((commission)) board on a form prepared and approved by the ((secretary with the approval of the commission)) board. Each applicant shall furnish proof satisfactory to the ((commission)) board 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, including but not limited to RCW 18.71.050(1) (a) through (c) 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 ((commission)) board;
     (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 adopted by the ((commission)) board;
     (4) That he or she has the ability to read, write, speak, understand, and be understood in the English language.

Sec. 115   RCW 18.71.055 and 1996 c 178 s 5 are each amended to read as follows:
     The ((commission)) board 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 ((commission)) board 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, 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 ((commission)) board;
     (3) Provides clinical instruction in hospital wards and out-patient clinics under guidance.
     Approval may be withdrawn by the ((commission)) board 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 ((commission)) board to approve a school of osteopathic medicine and surgery, or osteopathic medicine, for purposes of qualifying an applicant to be licensed under this chapter by direct licensure, reciprocity, or otherwise.

Sec. 116   RCW 18.71.060 and 1994 sp.s. c 9 s 310 are each amended to read as follows:
     The ((commission)) board 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. The record shall be evidence of all the proceedings of the ((commission)) board that are set forth in it.

Sec. 117   RCW 18.71.070 and 1994 sp.s. c 9 s 311 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 either administered or approved by the ((commission)) board to determine their professional qualifications. The ((commission)) board 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 ((commission)) board 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 ((commission)) board may by rule establish the passing grade for the examination.
     Examination results shall be part of the records of the ((commission)) board and shall be permanently kept with the applicant's file.

Sec. 118   RCW 18.71.080 and 1996 c 191 s 52 are each amended to read as follows:
     (1) Every person licensed to practice medicine in this state shall pay licensing fees established by the board under RCW 18.71.040 and renew his or her license in accordance with ((administrative)) the procedures and ((administrative)) requirements adopted ((as provided in RCW 43.70.250 and 43.70.280)) by the board.
     (2) The board shall establish by rule the procedures, requirements, and fees for initial issue, renewal, and reissue of a license to practice medicine under this chapter, including procedures and requirements for late renewals and uniform application of late renewal penalties. Failure to renew invalidates the license and all privileges granted by the license.
     (3) The board may, from time to time, extend or otherwise modify the duration of the licensing period, whether an initial or renewal period, if the board determines that it would result in a more economical or efficient operation of state government and that the public health, safety, or welfare would not be substantially adversely affected thereby. However, no license may be issued or approved for a period in excess of four years, without renewal. Such extension, reduction, or other modification of a licensing period shall be by rule of the board adopted in accordance with the provisions of chapter 34.05 RCW. Such rules may provide a method for imposing and collecting such additional proportional fee as may be required for the extended or modified period.
     (4) The ((commission)) board may establish rules governing mandatory continuing education requirements, which shall be met by physicians applying for renewal of licenses. The rules 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. The ((commission)) board, in its sole discretion, may permit an applicant who has not renewed his or her license 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. 119   RCW 18.71.085 and 1996 c 191 s 53 are each amended to read as follows:
     The ((commission)) board may adopt rules pursuant to this section authorizing an inactive license status.
     (1) An individual licensed pursuant to this 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 ((administrative)) procedures, ((administrative)) requirements, and fees for inactive renewal shall be established pursuant to RCW ((43.70.250 and 43.70.280)) 18.71.040 and 18.71.080.
     (3) An inactive license may be placed in an active status upon compliance with rules established by the ((commission)) board.
     (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. 120   RCW 18.71.090 and 1994 sp.s. c 9 s 314 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 ((commission)) board, be granted a license without examination on the payment of the fees required by this chapter: PROVIDED, That the applicant must file with the ((commission)) board 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. 121   RCW 18.71.095 and 2001 c 114 s 1 are each amended to read as follows:
     The ((commission)) board may, without examination, issue a limited license to persons who possess the qualifications set forth herein:
     (1) The ((commission)) board may, upon the written request of the secretary of the department of social and health services or the secretary of corrections, issue a limited license to practice medicine in this state to persons who have been accepted for employment by the department of social and health services or the department of corrections as physicians; who are licensed to practice medicine in another state of the United States or in the country of Canada or any province or territory thereof; and who meet all of the qualifications for licensure set forth in RCW 18.71.050.
     Such license shall permit the holder thereof to practice medicine only in connection with patients, residents, or inmates of the state institutions under the control and supervision of the secretary of the department of social and health services or the department of corrections.
     (2) The ((commission)) board may issue a limited license to practice medicine in this state to persons who have been accepted for employment by a county or city health department as physicians; who are licensed to practice medicine in another state of the United States or in the country of Canada or any province or territory thereof; and who meet all of the qualifications for licensure set forth in RCW 18.71.050.
     Such license shall permit the holder thereof to practice medicine only in connection with his or her duties in employment with the city or county health department.
     (3) Upon receipt of a completed application showing that the applicant meets all of the requirements for licensure set forth in RCW 18.71.050 except for completion of ((two)) three 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 ((commission)) board, the ((commission)) board may issue a limited license to a resident physician. Such license shall permit the resident physician to practice medicine only in connection with his or her duties as a resident physician and shall not authorize the physician to engage in any other form of practice. Each resident physician shall practice medicine only under the supervision and control of a physician licensed in this state, but such supervision and control shall not be construed to necessarily require the personal presence of the supervising physician at the place where services are rendered.
     (4)(a) Upon nomination by the dean of the school of medicine at the University of Washington or the chief executive officer of a hospital or other appropriate health care facility licensed in the state of Washington, the ((commission)) board may issue a limited license to a physician applicant invited to serve as a teaching-research member of the institution's instructional staff if the sponsoring institution and the applicant give evidence that he or she has graduated from a recognized medical school and has been licensed or otherwise privileged to practice medicine at his or her location of origin. Such license shall permit the recipient to practice medicine only within the confines of the instructional program specified in the application and shall terminate whenever the holder ceases to be involved in that program, or at the end of one year, whichever is earlier. Upon request of the applicant and the institutional authority, the license may be renewed.
     (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 ((commission)) board may issue a limited license to an applicant selected by the sponsoring institution to be enrolled in one of its designated departmental or divisional fellowship programs provided that the applicant shall have graduated from a recognized medical school and has been granted a license or other appropriate certificate to practice medicine in the location of the applicant's origin. Such license shall permit the holder only to practice medicine within the confines of the fellowship program to which he or she has been appointed and, upon the request of the applicant and the sponsoring institution, the license may be renewed by the ((commission)) board for no more than a total of two years.
     All persons licensed under this section shall be subject to the jurisdiction of the ((commission)) board to the same extent as other members of the medical profession, in accordance with this chapter and chapter ((18.130 RCW)) 18.-- RCW (sections 201 through 246 of this act).
     Persons applying for licensure and renewing licenses pursuant to this section shall comply with ((administrative)) procedures, ((administrative)) requirements, and fees determined by the board as provided in RCW ((43.70.250 and 43.70.280)) 18.71.040 and 18.71.080. Any person who obtains a limited license pursuant to this section may apply for licensure under this chapter, but shall submit a new application form and comply with all other licensing requirements of this chapter.

Sec. 122   RCW 18.71.205 and 1996 c 191 s 55 and 1996 c 178 s 6 are each reenacted and 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 ((commission)) board, shall prescribe:
     (a) Practice parameters, training standards for, and levels of, physician trained emergency medical service intermediate life support technicians and paramedics;
     (b) Minimum standards and performance requirements for the certification and recertification of physician's trained emergency medical service intermediate life support technicians and paramedics; and
     (c) Procedures for certification, recertification, and decertification of physician's trained emergency medical service intermediate life support technicians and paramedics.
     (2) Initial certification shall be for a period established by the secretary pursuant to RCW 43.70.250 and 43.70.280.
     (3) Recertification shall be granted upon proof of continuing satisfactory performance and education, and shall be for a period established by the secretary pursuant to RCW 43.70.250 and 43.70.280.
     (4) As used in this chapter((s 18.71)) and chapter 18.73 RCW, "approved medical program director" means a person who:
     (a) Is licensed to practice medicine and surgery pursuant to this chapter ((18.71 RCW)) or osteopathic medicine 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)) Medical Disciplinary Act, chapter ((18.130)) 18.-- RCW (sections 201 through 246 of this act), governs uncertified practice, the issuance and denial of certificates, and the disciplining of certificate holders under this section. The ((secretary)) board 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.
     (6) Such activities of physician's trained emergency medical service intermediate life support technicians and paramedics shall be limited to actions taken under the express written or oral order of medical program directors and shall not be construed at any time to include free standing or nondirected actions, for actions not presenting an emergency or life-threatening condition.

Sec. 123   RCW 18.71.230 and 1994 sp.s. c 9 s 317 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 ((commission)) board upon a finding by the ((commission)) board of an act of unprofessional conduct as defined in ((RCW 18.130.180)) section 229 of this act 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)) section 226 of this act. Such physician shall have the same rights of notice, hearing, and judicial review as provided licensed physicians generally under this chapter and chapter ((18.130 RCW)) 18.-- RCW (sections 201 through 246 of this act).

Sec. 124   RCW 18.71.300 and 1998 c 132 s 3 are each amended to read as follows:
     The definitions in this section apply throughout RCW 18.71.310 through 18.71.340 unless the context clearly requires otherwise.
     (1) "Entity" means a nonprofit corporation formed by physicians who have expertise in the areas of alcohol abuse, drug abuse, 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) by the ((commission)) board.
     (2) "Impaired" or "impairment" means the 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, monitoring, and treatment of impaired physicians established by the ((commission)) board 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)) board or entity for impaired physicians taking part in the impaired physician program created by RCW 18.71.310.

Sec. 125   RCW 18.71.310 and 2001 c 109 s 1 are each amended to read as follows:
     (1) The ((commission)) board shall enter into a contract with the entity to implement an impaired physician program. The ((commission)) board 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) Entering into relationships supportive of the impaired physician program with professionals who provide either evaluation or treatment services, or both;
     (b) Receiving and 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 for evaluation or treatment;
     (e) Monitoring the treatment and rehabilitation of impaired physicians including those ordered by the ((commission)) board;
     (f) Providing monitoring and continuing treatment and rehabilitative support of physicians;
     (g) Performing such other activities as agreed upon by the ((commission)) board and the 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 not less than twenty-five and not more than thirty-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 impaired physician account to be used solely for the implementation of the impaired physician program.

Sec. 126   RCW 18.71.315 and 1998 c 132 s 12 are each amended 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)) board or its executive director may authorize expenditures from the account. No appropriation is required for expenditures from this account.

Sec. 127   RCW 18.71.320 and 1998 c 132 s 5 are each amended to read as follows:
     The entity shall develop procedures in consultation with the ((commission)) board for:
     (1) Periodic reporting of statistical information regarding impaired physician activity;
     (2) Periodic disclosure and joint review of such information as the ((commission)) board may deem appropriate regarding reports received, contacts or investigations made, and the disposition of each report. However, the 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)) board 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)) board, in a timely fashion, any suspected or verified impaired physician who fails to cooperate with the entity, fails to submit to evaluation or treatment, or whose impairment is not substantially alleviated through treatment, or who, in the opinion of the entity, is probably unable 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. 128   RCW 18.71.330 and 1998 c 132 s 6 are each amended to read as follows:
     If the ((commission)) board has reasonable cause to believe that a physician is impaired, the ((commission)) board shall cause an evaluation of such physician to be conducted by the entity or the entity's designee or the ((commission's)) board's designee for the purpose of determining if there is an impairment. The entity or appropriate designee shall report the findings of its evaluation to the ((commission)) board.

Sec. 129   RCW 18.71.350 and 1994 sp.s. c 9 s 333 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 ((commission)) board 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.

NEW SECTION.  Sec. 130   (1) There is created in the state treasury an account to be known as the medical professions account. All fees or other funds received by the board for licenses, registration, certifications, renewals, or examinations and any civil penalties assessed and collected by the board under chapter 18.-- RCW (sections 201 through 246 of this act) shall be forwarded to the state treasurer who shall credit such moneys to the medical professions account. Any residue in the medical professions account shall be accumulated and shall not revert to the general fund at the end of the biennium. Any interest accrued from surplus funds in the medical professions account shall be deposited in the medical professions account and shall not revert to the general fund at the end of the biennium.
     (2) Expenditures from the medical professions account may be used only for the exclusive purpose of carrying out the licensing, disciplinary, and other functions of the board as set forth in chapters 18.71, 18.71A, and 18.-- (sections 201 through 246 of this act) RCW. The account is subject to allotment procedures under chapter 43.88 RCW, but no appropriation is required for expenditures from this account.
     (3) Only the board or its executive director may authorize expenditures from the medical professions account.
     (4) All funds not appropriated but deposited in the medical professions account from licensing fees and other funds collected from physician and physician assistants prior to July 2007 shall be transferred into the medical professions account by the state treasurer.

NEW SECTION.  Sec. 131   The board shall provide an annual report of its activities to the legislature and shall make itself available to answer questions of the legislature at such times as are mutually convenient to both the board and the legislature.

NEW SECTION.  Sec. 132   The definitions in this section apply throughout sections 133 through 138 of this act unless the context clearly requires otherwise.
     (1) "Entity" means a nonprofit corporation formed by physicians who have expertise in the areas of medical standards of care, ethical conduct, and other professional standards, and who broadly represent the physicians of the state of Washington, and has been designated to perform any or all of the activities set forth in section 134 of this act by the board.
     (2) "Physician education and improvement program" means a quality care improvement program that seeks to educate and improve physician proficiency with regard to quality of care, professional standards, ethical guidelines, and other practice standard issues established by the board pursuant to section 134 of this act.
     (3) "Physician" or "practitioner" means a person licensed under this chapter or chapter 18.71A RCW.

NEW SECTION.  Sec. 133   It is the purpose of the legislature to improve patient safety and the quality of patient care through the creation of an organization that will establish an education and improvement program to assist physicians and physician assistants whose care may be lacking in certain respects, but does not yet present an immediate threat to the public and is not yet actionable under the medical disciplinary act. The goal of the organization and its education and improvement program are to help improve the care of physicians and physician assistants, in a nonpunitive, confidential environment, that will result in safer and higher quality care to the citizens of this state.

NEW SECTION.  Sec. 134   (1) The board may enter into a contract with the entity to implement a physician education and improvement program. The board may enter into a contract with the entity for up to six years in length. The physician education and improvement program may include any or all of the following:
     (a) Entering into relationships supportive of the physician education and improvement program with professionals who provide the following services: Evaluation, education, or quality care improvement;
     (b) Receiving and assessing reports from any source raising issues with a physician's or physician assistant's care or conduct that may need improvement;
     (c) Intervening in cases of questionable behavior or care, or in cases where there is reasonable cause to suspect there is a quality of care or behavior issue;
     (d) Upon reasonable cause, referring physicians or physician assistants for evaluation, education, or quality improvement;
     (e) Monitoring the education and quality improvement of physicians and physician assistants;
     (f) Providing monitoring and continuing rehabilitative support of physicians and physician assistants;
     (g) Performing such other activities as agreed upon by the board and the entity; and
     (h) Providing prevention, education, and quality improvement services.
     (2) A contract entered into under subsection (1) of this section shall be financed by funds in the medical professions account; or if determined necessary by the board, a surcharge of not less than twenty-five and not more than thirty-five dollars per year on each license renewal or issuance of a new license to be collected by the board from every physician and surgeon licensed under this chapter in addition to other license fees. These moneys shall be placed in the physician education and improvement account to be used solely for the implementation of the physician education and improvement program.

NEW SECTION.  Sec. 135   The physician education and improvement account is created in the custody of the state treasurer. All receipts from section 134 of this act from license surcharges on physicians and physician assistants shall be deposited into the account. Expenditures from the account may only be used for the physician education and improvement program under sections 132 through 138 of this act. Only the board or its executive director may authorize expenditures from the account. No appropriation is required for expenditures from this account.

NEW SECTION.  Sec. 136   The entity shall develop procedures in consultation with the board for:
     (1) Periodic reporting of statistical information regarding physician education and improvement program activity;
     (2) Periodic disclosure and joint review of such information as the board may deem appropriate regarding reports received, contacts or investigations made, and the disposition of each report. However, the entity shall not disclose any personally identifiable information except as provided in subsections (3) and (4) of this section;
     (3) Immediate reporting to the board of the name and results of any contact or investigation regarding any physician who is reasonably believed to constitute a danger to himself or herself or to the public;
     (4) Reporting to the board, in a timely fashion, any physician who elects not to cooperate with the entity, who elects not to submit to evaluation or rehabilitation, whose problems are not substantially alleviated through education or a quality improvement course, or who, in the opinion of the entity, is unable to practice medicine with reasonable skill and safety;
     (5) Informing each participant of the physician education and improvement program of the program procedures, the responsibilities of program participants, and the possible consequences of noncompliance with the program.

NEW SECTION.  Sec. 137   (1) If the board has reasonable cause to believe that a physician's practice is deficient in some capacity, but the behavior is not egregious enough to constitute unprofessional conduct under the medical disciplinary act, chapter 18.-- RCW (sections 201 through 246 of this act), the board may cause an evaluation of such physician to be conducted by the entity or the entity's designee or the board's designee for the purpose of determining if education is appropriate for the physician. The entity or appropriate designee shall report the findings of its evaluation to the board.
     (2) The board shall establish by rule criteria for when a physician or physician assistant may be required to participate in the physician education and improvement program.
     (3) Refusing to participate in the physician education and improvement program or failure to complete the program is not by itself sufficient grounds for discipline under chapter 18.-- RCW (sections 201 through 246 of this act).

NEW SECTION.  Sec. 138   All entity records and all findings pursuant to sections 133 through 137 of this act are not subject to disclosure pursuant to chapter 42.56 RCW.

NEW SECTION.  Sec. 139   The governor or a designee of the governor shall meet annually with the board, a representative of the board, or its executive director, to establish performance measurement goals for the upcoming year, evaluate the previous year's goals, and review the rules, programs, and policies of the board as set forth in RCW 18.71.017, and any other matters of interest.

Sec. 140   RCW 18.71A.010 and 1994 sp.s. c 9 s 318 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 ((commission)) board to practice medicine to a limited extent only under the supervision of a physician as defined in chapter 18.71 RCW and who is academically and clinically prepared to provide health care services and perform diagnostic, therapeutic, preventative, and health maintenance services.
     (2) (("Commission")) "Board" means the Washington state medical ((quality assurance commission)) board for safety and quality.
     (3) "Practice medicine" 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. 141   RCW 18.71A.020 and 1999 c 127 s 1 are each amended to read as follows:
     (1) The ((commission)) board 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)) board and within one year successfully take and pass an examination approved by the ((commission)) board, if the examination tests subjects substantially equivalent to the curriculum of an accredited physician assistant training program. An interim permit may be granted by the department of health for one year provided the applicant meets all other requirements. Physician assistants licensed by the board of medical examiners, ((or)) the medical quality assurance commission, or the board as of ((July 1, 1999,)) the effective date of this section shall continue to be licensed.
     (2)(a) The ((commission)) 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 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)) board on a form prepared and approved by the ((secretary with the approval of the commission)) board, detailing the education, training, and experience of the physician assistant and such other information as the ((commission)) board may require. The application shall be accompanied by a fee determined by the ((secretary)) board as provided in RCW ((43.70.250 and 43.70.280)) 18.71.040 and 18.71.080. 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)) board 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)) board of the following:
     (a) That the applicant has completed an accredited physician assistant program approved by the ((commission)) board and is eligible to take the examination approved by the ((commission)) board;
     (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)) board 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)) board may approve, deny, or take other disciplinary action upon the application for license as provided in the ((Uniform)) medical disciplinary act, chapter ((18.130 RCW)) 18.-- RCW (sections 201 through 246 of this act). The license shall be renewed as determined under RCW ((43.70.250 and 43.70.280)) 18.71.040 and 18.71.080. The ((commission)) board may authorize the use of alternative supervisors who are licensed either under chapter 18.57 or 18.71 RCW.

Sec. 142   RCW 18.71A.025 and 1986 c 259 s 106 are each amended to read as follows:
     The ((uniform)) medical disciplinary act, chapter ((18.130 RCW)) 18.-- RCW (sections 201 through 246 of this act), governs the issuance and denial of licenses and the discipline of licensees under this chapter.

Sec. 143   RCW 18.71A.030 and 1994 sp.s. c 9 s 320 are each amended to read as follows:
     A physician assistant may practice medicine in this state only with the approval of the practice arrangement plan by the ((commission)) board and only to the extent permitted by the ((commission)) board. A physician assistant who has received a license but who has not received ((commission)) board 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)) 18.-- RCW (sections 201 through 246 of this act).

Sec. 144   RCW 18.71A.040 and 1996 c 191 s 58 and 1996 c 191 s 40 are each reenacted and 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 ((commission)) board.
     (2) Prior to commencing practice, a physician assistant licensed in this state shall apply to the ((commission)) board 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. ((Administrative)) Procedures, ((administrative)) requirements, and fees shall be established as provided in RCW ((43.70.250 and 43.70.280)) 18.71.040 and 18.71.080. 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 ((commission)) board may take disciplinary action under chapter ((18.130 RCW)) 18.-- RCW (sections 201 through 246 of this act).

Sec. 145   RCW 18.71A.050 and 1994 sp.s. c 9 s 323 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 ((commission)) board 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. 146   RCW 18.71A.085 and 1994 sp.s. c 9 s 325 are each amended to read as follows:
     Any physician assistant acupuncturist currently licensed by the ((commission)) board may continue to perform acupuncture under the physician assistant license as long as he or she maintains licensure as a physician assistant.

NEW SECTION.  Sec. 201   Protecting patients is one of the legislature's most important goals and a necessary component of an efficient health delivery system. Therefore, it is the intent of the legislature to improve patient safety by requiring greater accountability from the procedures, processes, and organization responsible for disciplining the state's licensed physicians and physician assistants through the establishment of a separate disciplinary act, the medical disciplinary act, with procedures and processes unique to the medical profession and the creation of a separate independent medical review body responsible for ruling on medical disciplinary cases.

NEW SECTION.  Sec. 202   The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.
     (1) "Board" means the Washington state medical board for safety and quality, which has the authority to take disciplinary action against a holder of, or applicant for, a license to practice medicine upon a finding of a violation of this chapter.
     (2) "Medical review panel" means an independent adjudicative panel responsible for acting as the impartial trier of fact and issuing final orders for all disciplinary hearings brought pursuant to this chapter.
     (3) "Medical law judge" means an attorney licensed in the state of Washington responsible for (a) ensuring all disciplinary hearings requested pursuant to this chapter are conducted in a fair and efficient manner, (b) presiding over all disciplinary hearings and ruling on all procedural and evidentiary motions, (c) assisting the medical review panel with other general issues of procedure and process, and (d) signing off on all orders, stipulations, subpoena requests, statements of charges, summary suspensions, or other actions taken by the board or the medical review panel.
     (4) "Unlicensed practice" means:
     (a) Practicing medicine without holding a valid, unexpired, unrevoked, and unsuspended license; or
     (b) Representing to a consumer, through offerings, advertisements, or use of a professional title or designation, that the individual is qualified to practice medicine, without holding a valid, unexpired, unrevoked, and unsuspended license to do so.
     (5) "Disciplinary action" means sanctions identified in section 224 of this act.
     (6) "Practice review" means an investigative audit of records related to the complaint, without prior identification of specific patient or consumer names, or an assessment of the conditions, circumstances, and methods of the professional's practice related to the complaint, to determine whether unprofessional conduct may have been committed.
     (7) "Health agency" means city and county health departments and the department of health.
     (8) "License," "licensing," and "licensure" shall be deemed equivalent to the terms "license," "licensing," "licensure," "certificate," "certification," and "registration" as those terms are defined in RCW 18.120.020.

NEW SECTION.  Sec. 203   (1) This chapter applies to the medical board for safety and quality and the physicians and physician assistants licensed under chapters 18.71 and 18.71A RCW.
     (2) In addition to the authority to discipline physician and physician assistant license holders, the board has the authority to grant or deny licenses, including granting of a license subject to conditions, based on the conditions and criteria established in this chapter and 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 section 224 of this act by the board or medical review panel.

NEW SECTION.  Sec. 204   The board has the following authority:
     (1) To adopt, amend, and rescind such rules as are deemed necessary to carry out this chapter, and, in consultation with the medical review panel, to adopt, amend, and rescind such rules as are deemed necessary to carry out the activities of the medical review panel as set forth in this chapter;
     (2) To investigate all complaints or reports of unprofessional conduct as defined in this chapter;
     (3) To issue subpoenas and administer oaths in connection with any investigation 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 or proceeding held under this chapter;
     (5) In the course of investigating a complaint or report of unprofessional conduct, to conduct practice reviews;
     (6) To take emergency action ordering summary suspension of a license, or restriction or limitation of the license holder's practice pending completion of all required proceedings provided for in this chapter. Consistent with section 241 of this act, the board shall issue a summary suspension of the license or temporary practice permit of a license holder prohibited from practicing medicine 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. The summary suspension remains in effect until all required proceedings provided for in this chapter have been completed;
     (7) To use individual members of the board to direct investigations;
     (8) To enter into contracts for professional services determined to be necessary for adequate enforcement of this chapter;
     (9) 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 board;
     (10) To adopt standards of professional conduct or practice;
     (11) 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;
     (12) 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;
     (13) 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 board 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);
     (14) To employ such investigative, administrative, and clerical staff as necessary for the enforcement of this chapter;
     (15) To establish fees to be paid for witnesses, expert witnesses, and consultants used in any investigation;
     (16) To conduct investigations and practice reviews, issue subpoenas, administer oaths, and take depositions in the course of conducting investigations and practice reviews;
     (17) To establish a system to recruit potential public members, review the qualifications of such potential members, and provide orientation to those public members appointed by the governor;
     (18) To adopt rules requiring every license holder to report information identified in section 209 of this act;
     (19) To appoint pro tem members to participate as members of the board or a panel of the board in connection with proceedings specifically identified by the board. Individuals so appointed must meet the same minimum qualifications as regular members of the board. 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 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 panel of the board shall be a regular member of the board appointed by the board chairperson. Board panels have authority to act as directed by the board with respect to all matters concerning the review, investigation, and settlement of all complaints, allegations, charges, and matters subject to the jurisdiction of the board. The authority to act through board panels 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 panels may make interim orders and issue final orders with respect to matters and cases delegated to the panel by the board.

NEW SECTION.  Sec. 205   The medical review panel has the following authority:
     (1) Assist the board with its responsibility of adopting, amending, and rescinding rules deemed necessary to carry out the activities of the medical review panel as set forth in this chapter;
     (2) In consultation with the board, enter into contracts for professional services determined necessary for administering this chapter;
     (3) Upon a finding, after a disciplinary 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 panel may issue an order pursuant to section 224 of this act;
     (4) Authorize the board to monitor, supervise, and enforce any sanction or order issued by the panel against a licensee;
     (5) Review all board summary suspensions within ten days for probable cause;
     (6) Appoint pro tem members to participate as members of the panel in connection with disciplinary proceedings. Individuals so appointed must meet the same minimum qualifications as regular members of the panel. 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 panel 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 panel.

NEW SECTION.  Sec. 206   The medical law judge has the following authority:
     (1) To schedule and preside over all disciplinary hearings as provided for in this chapter;
     (2) To rule on procedural and other motions, issue subpoenas, and administer oaths in connection with disciplinary hearings;
     (3) To compel attendance of witnesses at disciplinary hearings;
     (4) To sign off on all orders, stipulations, subpoena requests, statements of charges, summary suspensions, or other actions taken by the board or the medical review panel;
     (5) To employ such administrative and clerical staff as necessary for the enforcement of this chapter;
     (6) To provide legal, administrative, and other assistance as requested by the medical review panel;
     (7) To establish fees to witnesses in any disciplinary proceeding as authorized by RCW 34.05.446.

NEW SECTION.  Sec. 207   A decision on whether to issue a summary suspension or immediate restriction on a license pursuant to the board's authority under section 204(6) of this act, must be made by the board, or a panel of the board, within seventy-two hours of receipt of a completed case file that is ready for consideration and action.

NEW SECTION.  Sec. 208   (1) The board or a panel of the board may summarily suspend or restrict a license holder's license without a hearing if the board or panel of the board makes a good faith determination that the license holder poses an immediate threat to the public health and safety. Unless waived, within ten days of the suspension or restriction the license holder is entitled to a show cause hearing solely to determine whether or not the license holder poses an immediate threat to the public. The show cause hearing shall be before a medical review panel. At the show cause hearing, the medical review panel may consider all evidence and shall provide the license holder with an opportunity to provide testimony and be represented by legal counsel.
     (2) If the medical review panel determines that the license holder does not pose an immediate threat to the public health and safety, the panel may overturn the summary suspension or restriction order. If the panel determines that the license holder does in fact pose an immediate threat to the public health and safety the suspension or restriction remains in effect. The panel may also amend a board order so long as the amended order ensures the license holder will no longer pose an immediate threat to the public health and safety.
     (3) Within twenty days of the medical review panel's determination to sustain the suspension, the license holder may request a full hearing before a new medical review panel to contest the basis for the board's issuance of the summary suspension order. The full hearing before the medical review panel shall be scheduled by the medical law judge within ninety days of receipt of the request for a hearing.

NEW SECTION.  Sec. 209   (1)(a) The board shall adopt rules requiring every license holder to report to the board any conviction, determination, or finding that another license holder has committed an act which constitutes unprofessional conduct, or to report information to the board, an impaired practitioner program, voluntary substance abuse monitoring program approved by the board, or physician education and improvement program approved by the board, which indicates that the other 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) The board may adopt rules to require other persons, including corporations, organizations, health care facilities, impaired practitioner programs, voluntary substance abuse monitoring programs approved by the board, or physician education and improvement program approved by the board, and state or local government agencies to report:
     (i) Any conviction, determination, or finding that a license holder has committed an act which constitutes unprofessional conduct; or
     (ii) Information to the board, an impaired practitioner program, voluntary substance abuse monitoring program approved by the board, or physician education and improvement program approved by the board, 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.
     (c) If a report has been made by a hospital to the department of health pursuant to RCW 70.41.210, the department shall forward the report to the board. 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 board has committed an act which constituted unprofessional conduct and reporting any information which indicates that a federal employee or contractor regulated by the board may not be able to practice his or her profession with reasonable skill and safety as a result of a mental or physical condition.
     (d) Reporting under this section is not required by:
     (i) Any entity with a peer review committee, quality improvement committee, or other similarly designated professional review committee, or by a license holder who is a member of such committee, during the investigative phase of the respective committee's operations if the investigation is completed in a timely manner; or
     (ii) An impaired practitioner program, voluntary substance abuse monitoring program approved by the board, or physician education and improvement program approved by the board, if (A) the license holder is currently enrolled in the program, (B) the license holder actively participates in the program, and (C) the license holder's impairment does not constitute a clear and present danger to the public health, safety, or welfare.
     (2) If a person fails to furnish a required report, the board 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 board pursuant to the rules adopted under subsection (1) of this section.
     (4)(a) The holder of a license subject to the jurisdiction of this chapter shall report to the board:
     (i) Any conviction, determination, or finding that he or she has committed unprofessional conduct or is unable to practice with reasonable skill or safety; and
     (ii) Any disqualification from participation 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.
     (b) Failure to report within thirty days of notice of the conviction, determination, finding, or disqualification constitutes grounds for disciplinary action.

NEW SECTION.  Sec. 210   (1) If an individual licensed in another state that has licensing standards substantially equivalent to Washington applies for a license, the board shall issue a temporary practice permit authorizing the applicant to practice the profession pending completion of documentation that the applicant meets the requirements for a license and is also not subject to denial of a license or issuance of a conditional license under this chapter. The temporary permit may reflect statutory limitations on the scope of practice. The permit shall be issued only upon the board receiving verification from the states in which the applicant is licensed that the applicant is currently licensed and is not subject to charges or disciplinary action for unprofessional conduct or impairment. Notwithstanding RCW 34.05.422(3), the board shall establish, by rule, the duration of the temporary practice permits.
     (2) Failure to surrender the temporary practice permit is a misdemeanor under RCW 9A.20.010 and is unprofessional conduct under this chapter.
     (3) The issuance of temporary permits is subject to the provisions of this chapter, including summary suspensions.

NEW SECTION.  Sec. 211   (1) A person, including but not limited to consumers, licensees, corporations, organizations, health care facilities, impaired practitioner programs, voluntary substance abuse monitoring programs approved by the board, physician education and improvement programs approved by the board, and state and local governmental agencies, may submit a written complaint to the board charging a license holder or applicant with unprofessional conduct and specifying the grounds of the complaint or to report information to the board, voluntary substance abuse monitoring program, an impaired practitioner program approved by the board, or physician education and improvement program approved by the board, 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 board determines that the complaint merits investigation, or if the board has reason to believe, without a formal complaint, that a license holder or applicant may have engaged in unprofessional conduct, the board shall investigate to determine whether there has been unprofessional conduct. In determining whether or not to investigate, the board shall consider any prior complaints received by the board, any prior findings of fact under section 217 of this act, any stipulations to informal disposition under section 227 of this act, and any comparable action taken by other state disciplining authorities.
     (2) Notwithstanding subsection (1) of this section, the board shall initiate an investigation in every instance where the board receives information that a license holder 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.
     (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.

NEW SECTION.  Sec. 212   If the board communicates in writing to a complainant, or his or her representative, regarding his or her complaint, such communication shall not include the address or telephone number of the license holder against whom he or she has complained. The board shall inform all applicants for a license of the provisions of this section and chapter 42.56 RCW regarding the release of address and telephone information.

NEW SECTION.  Sec. 213   (1) If the board determines, upon investigation, that there is reason to believe a violation of section 229 of this act 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 before a medical review panel to contest the charge or charges. The license holder or applicant must file a request for hearing with the presiding medical law judge 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 medical law judge finds that there is good cause, the judge shall grant the extension. The failure to request a hearing constitutes a default, whereupon the board 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 medical law judge 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.

NEW SECTION.  Sec. 214   (1)(a) The board shall develop uniform procedural rules to respond to public inquiries concerning complaints and their disposition, active investigations, statements of charges, findings of fact, and final orders involving a licensee, applicant, or unlicensed person. Rules adopted by the board related to hearings before the medical review panel shall be developed by the board in consultation with the medical review panel. The procedural rules adopted under this subsection apply to all adjudicative proceedings conducted under this chapter and shall include provisions for establishing time periods for initial assessment, investigation, charging, discovery, settlement, and adjudication of complaints, and shall include enforcement provisions for violations of the specific time periods by the board, the medical review panel, and the respondent. Except when the notification would impede an effective investigation, a licensee must be notified upon receipt of a complaint, including, as determined by the board, an appropriate amount of information as to the nature of the complaint. At the earliest point of time the licensee must be allowed to submit a written statement about that complaint, which statement must be included in the file. Complaints are exempt from public disclosure under chapter 42.56 RCW until the complaint has been initially assessed and determined to warrant an investigation by the board. Complaints determined not to warrant an investigation by the board are no longer considered complaints, but must remain in the records and tracking system of the board. Information about complaints that did not warrant an investigation, including the existence of the complaint, may be released only upon receipt of a written public disclosure request or pursuant to an interagency agreement as provided in (b) of this subsection. Complaints determined to warrant no cause for action after investigation are subject to public disclosure, must include an explanation of the determination to close the complaint, and must remain in the records and tracking system of the board.
     (b) The board shall enter into interagency agreements for the exchange of records, which may include complaints filed but not yet assessed, with other state agencies if access to the records will assist those agencies in meeting their federal or state statutory responsibilities. Records obtained by state agencies under the interagency agreements are subject to the limitations on disclosure contained in (a) of this subsection.
     (2) The procedures for conducting investigations shall provide that prior to taking a written statement:
     (a) For violation of this chapter, the investigator shall inform such person, in writing of: (i) The nature of the complaint; (ii) that the person may consult with legal counsel at his or her expense prior to making a statement; and (iii) that any statement that the person makes may be used in an adjudicative proceeding conducted under this chapter; and
     (b) From a witness or potential witness in an investigation under this chapter, the investigator shall inform the person, in writing, that the statement may be released to the licensee, applicant, or unlicensed person under investigation if a statement of charges is issued.

NEW SECTION.  Sec. 215   (1) The settlement process must be uniform for all licensees governed under this chapter. The board may also use alternative dispute resolution to resolve complaints during adjudicative proceedings.
     (2) Disclosure of the identity of reviewing board members who participate in the settlement process is available to the respondent or his or her representative upon request.
     (3) The settlement conference will occur only if a settlement is not achieved through written documents. The respondent will have the opportunity to conference either by phone or in person with the reviewing board member if the respondent chooses. The respondent may also have his or her attorney conference either by phone or in person with the reviewing board member without the respondent being present personally.
     (4) If the respondent wants to meet in person with the reviewing board member, he or she will travel to the reviewing board member and have such a conference with another board representative in attendance either by phone or in person.

NEW SECTION.  Sec. 216   Except as otherwise set forth in this chapter, the procedures governing adjudicative proceedings before agencies under chapter 34.05 RCW, the administrative procedure act, govern all hearings before the medical review panel. The medical review panel and medical law judge have, in addition to the powers and duties set forth in this chapter, all of the powers and duties under chapter 34.05 RCW, which include, without limitation, all powers relating to the administration of oaths, the receipt of evidence, the issuance and enforcing of subpoenas, and the taking of depositions.

NEW SECTION.  Sec. 217   (1) In the event of a finding of unprofessional conduct, the board or the medical review panel, as the case may be, shall prepare and serve findings of fact and an order as provided in chapter 34.05 RCW, the administrative procedure act. If the license holder or applicant is found to have not committed unprofessional conduct by the board or after a hearing by the medical review panel, the board or the medical review panel, as the case may be, shall forthwith prepare and serve findings of fact and an order of dismissal of the charges, including public exoneration of the licensee or applicant. The findings of fact and order shall be retained by the board or the medical review panel, as the case may be, as a permanent record.
     (2) The board shall report the issuance of statements of charges and final orders, including final orders issued by the medical review panel, to:
     (a) The person or agency who brought to the board's attention information which resulted in the initiation of the case;
     (b) Appropriate organizations, public or private, which serve the professions;
     (c) The public. Notification of the public shall include press releases to appropriate local news media and the major news wire services; and
     (d) Counterpart licensing boards in other states, or associations of state licensing boards.
     (3) This section shall not be construed to require the reporting of any information which is exempt from public disclosure under chapter 42.56 RCW.

NEW SECTION.  Sec. 218   The board shall not issue any license to any person whose license has been denied, revoked, or suspended by the board or medical review panel except in conformity with the terms and conditions of the certificate or order of denial, revocation, or suspension, or in conformity with any order of reinstatement issued by the board or medical review panel, or in accordance with the final judgment in any proceeding for review instituted under this chapter.

NEW SECTION.  Sec. 219   The board shall suspend the license of any person who has been certified by a lending agency and reported to the board for nonpayment or default on a federally or state-guaranteed educational loan or service-conditional scholarship. Prior to the suspension, the board must provide the person an opportunity for a brief adjudicative proceeding under RCW 34.05.485 through 34.05.494 and issue a finding of nonpayment or default on a federally or state-guaranteed educational loan or service-conditional scholarship. The person's license shall not be reissued until the person provides the board with a written release issued by the lending agency stating that the person is making payments on the loan in accordance with a repayment agreement approved by the lending agency. If the person has continued to meet all other requirements for licensure during the suspension, reinstatement shall be automatic upon receipt of the notice and payment of any reinstatement fee the board may impose.

NEW SECTION.  Sec. 220   The board shall immediately suspend the license of any person subject to this chapter who has been certified by the department of social and health services as a person who is not in compliance with a support order as provided in RCW 74.20A.320.

NEW SECTION.  Sec. 221   An order pursuant to proceedings authorized by this chapter, after due notice and findings in accordance with this chapter and chapter 34.05 RCW, or an order of summary suspension entered under this chapter, shall take effect immediately upon its being served. The order, if appealed to the court, shall not be stayed pending the appeal unless the board or medical review panel that issued the order or court to which the appeal is taken enters an order staying the order of the board or medical review panel, which stay shall provide for terms necessary to protect the public.

NEW SECTION.  Sec. 222   An individual who has been disciplined or whose license has been denied by the board or medical review panel may appeal the decision as provided in chapter 34.05 RCW.

NEW SECTION.  Sec. 223   A person whose license has been suspended or revoked under this chapter may petition the board for reinstatement after an interval as determined by the board or medical review panel in its order. The board shall hold hearings on the petition and may deny the petition or may order reinstatement and impose terms and conditions as provided in section 224 of this act and issue an order of reinstatement. The board may require successful completion of an examination as a condition of reinstatement.
     A person whose license has been suspended for noncompliance with a support order under RCW 74.20A.320 may petition for reinstatement at any time by providing the board a release issued by the department of social and health services stating that the person is in compliance with the order. If the person has continued to meet all other requirements for reinstatement during the suspension, the board shall automatically reissue the person's license upon receipt of the release, and payment of a reinstatement fee, if any.

NEW SECTION.  Sec. 224   Upon a finding, after hearing before the medical review panel, 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 medical review panel may consider the imposition of sanctions, taking into account any prior findings of fact under section 217 of this act, any stipulations to informal disposition under section 227 of this act, and any action taken by other in-state or out-of-state disciplining authorities, and issue an order providing for one or any combination of the following:
     (1) Revocation of the license;
     (2) Suspension of the license for a fixed or indefinite term;
     (3) Restriction or limitation of the practice;
     (4) Requiring the satisfactory completion of a specific program of remedial education or treatment;
     (5) The monitoring of the practice by a supervisor approved by the medical review panel;
     (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 medical 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 medical review panel. Safeguarding the public's health and safety is the paramount responsibility of the medical review panel and in determining what action is appropriate, the medical review panel must first consider what sanctions are necessary to protect or compensate the public. Only after such provisions have been made may the medical review panel consider and include in the order requirements designed to rehabilitate the license holder or applicant. All costs associated with compliance with orders issued under this section are the obligation of the license holder or applicant.
     The licensee or applicant may enter into a stipulated disposition of charges with the board that includes one or more of the sanctions of this section, but only after a statement of charges has been issued and the licensee has been afforded the opportunity for a hearing before the medical review panel and has elected on the record to forego such a hearing. The stipulation shall either contain one or more specific findings of unprofessional conduct or inability to practice, or a statement by the licensee acknowledging that evidence is sufficient to justify one or more specified findings of unprofessional conduct or inability to practice. The stipulation entered into pursuant to this subsection shall be considered formal disciplinary action for all purposes.

NEW SECTION.  Sec. 225   Where an order for payment of a fine is made as a result of a hearing under section 216 or 231 of this act and timely payment is not made as directed in the final order, the board may enforce the order for payment in the superior court in the county in which the hearing was held. This right of enforcement shall be in addition to any other rights the board may have as to any licensee ordered to pay a fine but shall not be construed to limit a licensee's ability to seek judicial review under section 222 of this act.
     In any action for enforcement of an order of payment of a fine, the board or medical panel's order, as the case may be, is conclusive proof of the validity of the order of payment of a fine and the terms of payment.

NEW SECTION.  Sec. 226   (1) If the board 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 board shall be served on the license holder or applicant and notice shall also be issued providing an opportunity for a hearing before the medical review panel. 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 medical review panel 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 medical review panel shall impose such sanctions under section 224 of this act as is deemed necessary to protect the public. If the license holder chooses not to have the case heard before the medical review panel, the board must assume the allegations raised in the statement of charges are correct and shall impose sanctions under section 224 of this act as is deemed necessary to protect the public.
     (2)(a) In investigating 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 board 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 board. The license holder or applicant shall be provided written notice of the board'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 board'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 board'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 the medical review panel. The medical review panel may, in its discretion, ask for oral argument from the parties. The medical review panel 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 that is appropriate, or both.
     (c) Upon receipt by the board of the written decision, or upon the failure of the license holder or applicant to timely respond to the notice of intent, the board 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 board 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 board shall be paid out of the medical professions account. In addition to any examinations ordered by the board, the licensee 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 board finds that a license holder or applicant has failed to submit to a properly ordered mental or physical examination, then the board may order appropriate action or discipline under section 229(9) of this act, 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 board'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 the medical review panel. Further, the action or discipline ordered by the board 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 restricts the power of the board to act in an emergency under RCW 34.05.422(4), 34.05.479, and section 204(6) of this act.
     (f) A determination by a court of competent jurisdiction that a license holder or applicant is mentally incompetent or mentally ill 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 board and further to have waived all objections to the admissibility or use of the examining health professional's testimony or examination reports by the board on the ground that the testimony or reports constitute privileged communications.

NEW SECTION.  Sec. 227   (1) Prior to serving a statement of charges under section 213 or 226 of this act, the board 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 board 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 section 224 of this act, except section 224 (1), (2), (6), and (8) of this act, 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 board 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 board 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 board may proceed to formal disciplinary action pursuant to section 213 or 226 of this act.
     (4) Upon execution of a stipulation under subsection (2) of this section by both the licensee or applicant and the board, 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 board. Should the licensee or applicant fail to pay any agreed reimbursement within thirty days of the date specified in the stipulation for payment, the board may seek collection of the amount agreed to be paid in the same manner as enforcement of a fine under section 225 of this act.

NEW SECTION.  Sec. 228   (1) In lieu of disciplinary action under section 224 of this act and if the board determines that the unprofessional conduct may be the result of substance abuse, the board may refer the license holder to a voluntary substance abuse monitoring program approved by the board.
     The cost of the treatment is 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 or by any other provider approved by the board. However, nothing shall prohibit the board from approving additional services and programs as an adjunct to primary alcoholism or other drug addiction treatment. The board 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 board may take appropriate action under section 224 of this act which includes suspension of the license unless or until the board, in consultation with the director of the voluntary substance abuse monitoring program, determines the license holder is able to practice safely. The board shall adopt rules for the evaluation 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 board 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 board, the board may establish by rule requirements for participation of license holders who are not being investigated or monitored by the board for substance abuse. License holders voluntarily participating in the approved programs without being referred by the board shall not be subject to disciplinary action under section 224 of this act for their substance abuse, and shall not have their participation made known to the board, 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 board 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 board 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 board 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 board, 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 are confidential, exempt from chapter 42.56 RCW, and not subject to discovery by subpoena or admissible as evidence except for monitoring records reported to the board for cause as defined in subsection (3) of this section. Monitoring records relating to license holders referred to the program by the board or relating to license holders reported to the board by the program for cause shall be released to the board at the request of the board. Records held by the board under this section are exempt from chapter 42.56 RCW and are not 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 board, 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 board 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 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 or substantive grounds, or both.
     (c) The immunity provided in this section is in addition to any other immunity provided by law.

NEW SECTION.  Sec. 229   The following conduct, acts, or conditions constitute unprofessional conduct for any license holder or applicant under the jurisdiction of this chapter:
     (1) The commission of any act involving moral turpitude, dishonesty, or corruption relating to the practice of medicine, whether the act constitutes a crime or not. If the act constitutes a crime, conviction in a criminal proceeding is not a condition precedent to disciplinary action. Upon such a conviction, however, the judgment and sentence is conclusive evidence at the ensuing disciplinary hearing of the guilt of the license holder or applicant of the crime described in the indictment or information, and of the person's violation of the statute on which it is based. For the purposes of this section, conviction includes all instances in which a plea of guilty or nolo contendere is the basis for the conviction and all proceedings in which the sentence has been deferred or suspended. Nothing in this section abrogates rights guaranteed under chapter 9.96A RCW;
     (2) Misrepresentation or concealment of a material fact in obtaining a license or in reinstatement thereof;
     (3) All advertising which is false, fraudulent, or misleading;
     (4) Incompetence, negligence, or malpractice which results in injury to a patient or which creates an unreasonable risk that a patient may be harmed. The use of a nontraditional treatment by itself does not constitute unprofessional conduct, provided that it does not result in injury to a patient or create an unreasonable risk that a patient may be harmed;
     (5) Suspension, revocation, or restriction of the individual's license to practice medicine by a competent authority in any state, federal, or foreign jurisdiction, a certified copy of the order, stipulation, or agreement being conclusive evidence of the revocation, suspension, or restriction;
     (6) The possession, use, prescription for use, or distribution of controlled substances or legend drugs in any way other than for legitimate or therapeutic purposes, diversion of controlled substances or legend drugs, the violation of any drug law, or prescribing controlled substances for oneself;
     (7) Violation of any state or federal statute or administrative rule regulating the practice of medicine, including any statute or rule defining or establishing standards of patient care or professional conduct or practice;
     (8) Failure to cooperate with the board or the medical review panel by:
     (a) Not furnishing any papers or documents;
     (b) Not furnishing in writing a full and complete explanation covering the matter contained in the complaint filed with the board;
     (c) Not responding to subpoenas issued by the board or the medical review panel, whether or not the recipient of the subpoena is the accused in the proceeding; or
     (d) Not providing reasonable and timely access for authorized representatives of the board seeking to perform practice reviews at facilities utilized by the license holder;
     (9) Failure to comply with an order issued by the board or the medical review panel or a stipulation for informal disposition entered into with the board;
     (10) Aiding or abetting an unlicensed person to practice when a license is required;
     (11) Violations of rules established by any health agency;
     (12) Practice beyond the scope of practice as defined by law or rule;
     (13) Misrepresentation or fraud in any aspect of the conduct of the business or profession;
     (14) Failure to adequately supervise auxiliary staff to the extent that the consumer's health or safety is at risk;
     (15) Engaging in the practice of medicine involving contact with the public while suffering from a contagious or infectious disease involving serious risk to public health;
     (16) Promotion for personal gain of any unnecessary or inefficacious drug, device, treatment, procedure, or service;
     (17) Conviction of (a) a felony, or (b) any gross misdemeanor relating to the practice of the person's profession. For the purposes of this subsection, conviction includes all instances in which a plea of guilty or nolo contendere is the basis for conviction and all proceedings in which the sentence has been deferred or suspended. Nothing in this section abrogates rights guaranteed under chapter 9.96A RCW;
     (18) The procuring, or aiding or abetting in procuring, a criminal abortion;
     (19) The offering, undertaking, or agreeing to cure or treat disease by a secret method, procedure, treatment, or medicine, or the treating, operating, or prescribing for any health condition by a method, means, or procedure which the licensee refuses to divulge upon demand of the board;
     (20) The willful betrayal of a practitioner-patient privilege as recognized by law;
     (21) Violation of chapter 19.68 RCW;
     (22) Interference with an investigation or disciplinary proceeding by willful misrepresentation of facts before the board or its authorized representative, or by the use of threats or harassment against any patient or witness to prevent him or her from providing evidence in a disciplinary proceeding or any other legal action, or by the use of financial inducements to any patient or witness to prevent or attempt to prevent him or her from providing evidence in a disciplinary proceeding;
     (23) Current misuse of:
     (a) Alcohol;
     (b) Controlled substances; or
     (c) Legend drugs;
     (24) Abuse of a client or patient or sexual contact with a client or patient;
     (25) Acceptance of more than a nominal gratuity, hospitality, or subsidy offered by a representative or vendor of medical or health-related products or services intended for patients, in contemplation of a sale or for use in research publishable in professional journals, where a conflict of interest is presented, as defined by rules of the board, based on recognized professional ethical standards;
     (26) When requested by the board, upon application, renewal, or otherwise, the failure of a licensee or applicant to report to the board final actions taken against him or her by another licensing jurisdiction, peer review body, health care institution, professional or medical society or association, governmental agency, law enforcement agency, or court for acts or conduct similar to acts or conduct that would constitute unprofessional conduct under this section.

NEW SECTION.  Sec. 230   If a person regulated by this chapter violates section 226 or 229 of this act, the attorney general, any prosecuting attorney, the board, or any other person may maintain an action in the name of the state of Washington to enjoin the person from committing the violations. The injunction shall not relieve the offender from criminal prosecution, but the remedy by injunction shall be in addition to the liability of the offender to criminal prosecution and disciplinary action.

NEW SECTION.  Sec. 231   (1) The board shall investigate complaints concerning the practice of medicine by unlicensed persons.
     (2) The board may issue a notice of intention to issue a cease and desist order to any person whom the board has reason to believe is engaged in the unlicensed practice of medicine. The person to whom such notice is issued may request an adjudicative proceeding before the medical review panel to contest the charges. The request for hearing must be filed within twenty days after service of the notice of intention to issue a cease and desist order. The failure to request a hearing constitutes a default, whereupon the board may enter a permanent cease and desist order, which may include a civil fine. All proceedings shall be conducted in accordance with chapter 34.05 RCW.
     (3) If the medical review panel makes a final determination that a person has engaged or is engaging in unlicensed practice of medicine, the medical review panel may issue a cease and desist order. In addition, the medical review panel may impose a civil fine in an amount not exceeding one thousand dollars for each day upon which the person engaged in unlicensed practice of medicine. The proceeds of such fines shall be deposited into the medical professions account.
     (4) If the board makes a written finding of fact that the public interest will be irreparably harmed by delay in issuing an order, the board may issue a temporary cease and desist order. The person receiving a temporary cease and desist order shall be provided an opportunity for a prompt hearing before a medical review panel. The temporary cease and desist order shall remain in effect until further order of the medical review panel. The failure to request a prompt or regularly scheduled hearing constitutes a default, whereupon the board may enter a permanent cease and desist order, which may include a civil fine.
     (5) Neither the issuance of a cease and desist order nor payment of a civil fine relieves the person so practicing without a license from criminal prosecution, but the remedy of a cease and desist order or civil fine is in addition to any criminal liability. The cease and desist order is conclusive proof of unlicensed practice and may be enforced under RCW 7.21.060. This method of enforcement of the cease and desist order or civil fine may be used in addition to, or as an alternative to, any provisions for enforcement of agency orders set out in chapter 34.05 RCW.
     (6) The attorney general, a county prosecuting attorney, the board, or any person may in accordance with the laws of this state governing injunctions, maintain an action in the name of this state to enjoin any person practicing medicine without a license from engaging in such practice until the required license is secured. However, the injunction does not relieve the person practicing without a license from criminal prosecution, but the remedy by injunction is in addition to any criminal liability.
     (7)(a) Unlicensed practice of medicine, unless otherwise exempted by law, constitutes a gross misdemeanor for a single violation.
     (b) Each subsequent violation, whether alleged in the same or in subsequent prosecutions, is a class C felony punishable according to chapter 9A.20 RCW.
     (8) All fees, fines, forfeitures, and penalties collected or assessed by a court because of a violation of this section shall be remitted to the medical professions account.

NEW SECTION.  Sec. 232   A person that violates an injunction issued under this chapter shall pay a civil penalty, as determined by the court, of not more than twenty-five thousand dollars, which shall be placed in the medical professions account. For the purpose of this section, the superior court issuing any injunction shall retain jurisdiction and the cause shall be continued, and in such cases the attorney general acting in the name of the state may petition for the recovery of civil penalties.

NEW SECTION.  Sec. 233   A person who attempts to obtain, obtains, or attempts to maintain a license by willful misrepresentation or fraudulent representation is guilty of a gross misdemeanor.

NEW SECTION.  Sec. 234   If the board determines or has cause to believe that a license holder has committed a crime, the board, immediately subsequent to issuing findings of fact and a final order, shall notify the attorney general or the county prosecuting attorney in the county in which the act took place of the facts known to the board.

NEW SECTION.  Sec. 235   The board may adopt rules pursuant to this section authorizing a retired active license status. Such a licensee shall meet the continuing education or continued competency requirements, if any, established by the board for renewals and is subject to the provisions of this chapter. Individuals who have entered into retired status agreements with the board in any jurisdiction do not qualify for a retired active license under this section.

NEW SECTION.  Sec. 236   (1) The board, medical review panel, medical law judge, 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, an impaired practitioner program, or a physician education and improvement program, approved by the board, 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. 237   Subject to RCW 40.07.040, the board shall submit a biennial report to the legislature on its proceedings during the biennium, detailing the number of complaints made, investigated, and adjudicated and manner of disposition. The report may include recommendations for improving the disciplinary process, including proposed legislation. The board shall develop a uniform report format.

NEW SECTION.  Sec. 238   The department of health shall coordinate and assist the board with prescriptive authority in the development of uniform guidelines for addressing opiate therapy for acute pain, chronic pain associated with cancer and other terminal diseases, and other chronic or intractable pain conditions. The purpose of the guidelines is to assure the provision of effective medical treatment in accordance with recognized national standards and consistent with requirements of the public health and safety.

NEW SECTION.  Sec. 239   This chapter does not affect the use of records, obtained from the board, in any existing investigation or action by any state agency. Nor does this chapter limit any existing exchange of information between the board and other state agencies.

NEW SECTION.  Sec. 240   (1) As used in this section, "emergency or disaster" has the same meaning as in RCW 38.52.010.
     (2) The board shall issue a retired volunteer medical worker license to any applicant who:
     (a) Has held an active license issued by the board no more than ten years prior to applying for an initial license under this section;
     (b) Does not have any current restrictions on the ability to obtain a license for violations of this chapter; and
     (c) Submits proof of registration as a volunteer with a local organization for emergency services or management as defined by chapter 38.52 RCW.
     (3) License holders under this section must be supervised and may practice only those duties that correspond to the scope of their emergency worker assignment not to exceed their scope of practice prior to retirement.
     (4) The board shall adopt rules and policies to implement this section.
     (5) The board shall establish standards for the renewal of licenses issued under this section, including continuing competency requirements.
     (6) License holders under this section are subject to the provisions of this chapter as they may apply to the issuance and denial of credentials, unauthorized practice, and discipline for acts of unprofessional conduct.
     (7) Nothing in this section precludes a physician or physician assistant who holds an active license from providing medical services during an emergency or disaster.

NEW SECTION.  Sec. 241   Any individual who applies for a license or temporary practice permit or holds a license or temporary practice permit and is prohibited from practicing medicine in another state because of an act of unprofessional conduct that is substantially equivalent to an act of unprofessional conduct prohibited by this chapter is prohibited from practicing medicine in this state until proceedings of the board have been completed under this chapter.

NEW SECTION.  Sec. 242   (1) This chapter may be known and cited as the medical disciplinary act.
     (2) This chapter applies to any conduct, acts, or conditions occurring on or after the effective date of this section.
     (3) This chapter does not apply to or govern the construction of and disciplinary action for any conduct, acts, or conditions occurring prior to the effective date of this section. Such conduct, acts, or conditions must be construed and disciplinary action taken according to the provisions of law existing at the time of the occurrence in the same manner as if this chapter had not been enacted.

NEW SECTION.  Sec. 243   There is created an independent medical review panel for the state of Washington to be known as the Washington state medical review panel. The panel shall consist of fourteen members appointed by the governor who either previously served, including as a pro tem member, on the former medical quality assurance commission or the board, or are currently licensed to practice medicine in the state of Washington under chapter 18.71 RCW. Members of the panel shall include two physician assistants, four public members, and eight physician members. Members of the initial panel may be appointed to staggered terms of one to four years, and thereafter all terms of appointment shall be for four years. There is not a limit as to the number of former commission or board members that may serve on the panel at any one time.
     Prior to each disciplinary hearing a three-person hearing panel shall be selected from the medical review panel to hear and rule on the case. If the hearing is requested by a physician, then the hearing panel shall consist of two physicians and one public panel member. If the hearing is requested by a physician assistant, then the hearing panel shall consist of one physician assistant, one physician, and one public panel member.
     A majority of the hearing panel shall make all determinations as to findings of unprofessional conduct or other violations of the medical disciplinary act, and determinations of final actions against the licensee pursuant to section 217 of this act.

NEW SECTION.  Sec. 244   The governor shall appoint three medical law judges. The initial judges may be appointed to staggered terms of two to six years, and thereafter all terms of appointment shall be for six years. Each judge shall preside as acting judge for one four-month term each year. As acting judge the medical law judge is responsible for carrying out the duties and responsibilities set forth in this section.
     The judges must have the following minimum qualifications: Be licensed to practice in the state of Washington, be in good standing with the state bar, and have a minimum of five years' experience in health law, including familiarity with medical disciplinary issues. The ideal candidate will also have judicial experience as a pro tem justice or other similar experience.
     A medical law judge shall be present at all disciplinary hearings to provide the hearing panel with assistance as necessary and shall rule on all procedural, evidentiary, and other motions raised by the parties. The medical law judge does not participate in the hearing panel's deliberation or ruling process.
     The medical law judge shall also:
     (1) Schedule all disciplinary hearings as provided for in this chapter;
     (2) Rule on all procedural and other motions, issue subpoenas, and administer oaths in connection with disciplinary hearings;
     (3) Compel attendance of witnesses at disciplinary hearings;
     (4) Sign off on all orders, stipulations, subpoena requests, statements of charges, summary suspensions, or other actions taken by the board or the medical review panel;
     (5) Employ such administrative and clerical staff as necessary for the enforcement of this chapter;
     (6) Provide legal, administrative, and other assistance to the medical review panel;
     (7) Establish fees to witnesses in any disciplinary proceeding as authorized by RCW 34.05.446.

NEW SECTION.  Sec. 245   The board is responsible for funding the functions and obligations of the medical review panel and medical law judges under this chapter and ensuring that all activities of the medical review panel and medical law judges remain independent from the board's activities. The board, in collaboration with the panel, shall adopt rules necessary for the medical review panel and medical law judges to fulfill their obligations under this chapter. Compensation of the panel, including the medical law judges, shall be determined by the board.
     Whenever the governor is satisfied that a member of the medical review panel or a medical law judge 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.
     A vacancy on the medical review panel or as a medical law judge shall be filled for the unexpired term by appointment by the governor as set forth in section 244 of this act.
     The members of the medical review panel and the medical law judges are immune from suit in an action, civil or criminal, based on their official acts performed in good faith as members of the medical review panel or as medical law judges.

NEW SECTION.  Sec. 246   (1) The board 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.
     (2) The board shall specify those situations where a background check under subsection (1) of this section 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. The board shall issue a temporary practice permit to an applicant who must have a national background check conducted if the background check under subsection (1) of this section does not reveal a criminal record in Washington, and if the applicant meets the provisions of RCW 18.130.075.

NEW SECTION.  Sec. 301   (1) The medical quality assurance commission is hereby abolished and its powers, duties, and functions are hereby transferred to the medical board for safety and quality. All references to the medical quality assurance commission in the Revised Code of Washington shall be construed to mean the medical board for safety and quality.
     (2)(a) All reports, documents, surveys, books, records, files, papers, or written material in the possession of the medical quality assurance commission shall be delivered to the custody of the medical board for safety and quality. All cabinets, furniture, office equipment, motor vehicles, and other tangible property employed by the medical quality assurance commission shall be made available to the medical board for safety and quality. All funds, credits, or other assets held by the medical quality assurance commission shall be assigned to the medical board for safety and quality.
     (b) Any appropriations made to the medical quality assurance commission shall, on the effective date of this section, be transferred and credited to the medical board for safety and quality.
     (c) If any question arises as to the transfer of any personnel, funds, books, documents, records, papers, files, equipment, or other tangible property used or held in the exercise of the powers and the performance of the duties and functions transferred, the director of financial management shall make a determination as to the proper allocation and certify the same to the state agencies concerned.
     (3) All employees of the medical quality assurance commission are transferred to the jurisdiction of the medical board for safety and quality. All employees classified under chapter 41.06 RCW, the state civil service law, are assigned to the medical board for safety and quality to perform their usual duties upon the same terms as formerly, without any loss of rights, subject to any action that may be appropriate thereafter in accordance with the laws and rules governing state civil service.
     (4) All rules and all pending business before the medical quality assurance commission shall be continued and acted upon by the medical board for safety and quality. All existing contracts and obligations shall remain in full force and shall be performed by the medical board for safety and quality.
     (5) The transfer of the powers, duties, functions, and personnel of the medical quality assurance commission shall not affect the validity of any act performed before the effective date of this section.
     (6) If apportionments of budgeted funds are required because of the transfers directed by this section, the director of financial management shall certify the apportionments to the agencies affected, the state auditor, and the state treasurer. Each of these shall make the appropriate transfer and adjustments in funds and appropriation accounts and equipment records in accordance with the certification.
     (7) Nothing contained in this section may be construed to alter any existing collective bargaining unit or the provisions of any existing collective bargaining agreement until the agreement has expired or until the bargaining unit has been modified by action of the public employment relations commission as provided by law.

NEW SECTION.  Sec. 302   (1) All powers, duties, and functions of the department of health pertaining to licensing and disciplining of physicians and physician assistants are transferred to the medical board for safety and quality. All references to the secretary or the department of health in the Revised Code of Washington shall be construed to mean the medical board for safety and quality when referring to the functions transferred in this section.
     (2)(a) All reports, documents, surveys, books, records, files, papers, or written material in the possession of the department of health pertaining to the powers, functions, and duties transferred shall be delivered to the custody of the medical board for safety and quality. All cabinets, furniture, office equipment, motor vehicles, and other tangible property employed by the department of health in carrying out the powers, functions, and duties transferred shall be made available to the medical board for safety and quality. All funds, credits, or other assets held in connection with the powers, functions, and duties transferred shall be assigned to the medical board for safety and quality.
     (b) Any appropriations made to the department of health for carrying out the powers, functions, and duties transferred shall, on the effective date of this section, be transferred and credited to the medical board for safety and quality.
     (c) Whenever any question arises as to the transfer of any personnel, funds, books, documents, records, papers, files, equipment, or other tangible property used or held in the exercise of the powers and the performance of the duties and functions transferred, the director of financial management shall make a determination as to the proper allocation and certify the same to the state agencies concerned.
     (3) All employees of the department of health engaged in performing the powers, functions, and duties transferred are transferred to the jurisdiction of the medical board for safety and quality. All employees classified under chapter 41.06 RCW, the state civil service law, are assigned to the medical board for safety and quality to perform their usual duties upon the same terms as formerly, without any loss of rights, subject to any action that may be appropriate thereafter in accordance with the laws and rules governing state civil service.
     (4) All rules and all pending business before the department of health pertaining to the powers, functions, and duties transferred shall be continued and acted upon by the medical board for safety and quality. All existing contracts and obligations shall remain in full force and shall be performed by the medical board for safety and quality.
     (5) The transfer of the powers, duties, functions, and personnel of the department of health shall not affect the validity of any act performed before the effective date of this section.
     (6) If apportionments of budgeted funds are required because of the transfers directed by this section, the director of financial management shall certify the apportionments to the agencies affected, the state auditor, and the state treasurer. Each of these shall make the appropriate transfer and adjustments in funds and appropriation accounts and equipment records in accordance with the certification.
     (7) Nothing contained in this section may be construed to alter any existing collective bargaining unit or the provisions of any existing collective bargaining agreement until the agreement has expired or until the bargaining unit has been modified by action of the public employment relations commission as provided by law.

Sec. 303   RCW 18.130.040 and 2007 c 269 s 17 and 2007 c 70 s 11 are each reenacted and 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 and designated apprentices 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 licensed under chapter 18.06 RCW;
     (viii) Radiologic technologists certified and X-ray technicians registered under chapter 18.84 RCW;
     (ix) Respiratory care practitioners licensed under chapter 18.89 RCW;
     (x) Persons registered under chapter 18.19 RCW;
     (xi) Persons licensed as mental health counselors, marriage and family therapists, and social workers under chapter 18.225 RCW;
     (xii) Persons registered as nursing pool operators under chapter 18.52C RCW;
     (xiii) Nursing assistants registered or certified under chapter 18.88A RCW;
     (xiv) Health care assistants certified under chapter 18.135 RCW;
     (xv) Dietitians and nutritionists certified under chapter 18.138 RCW;
     (xvi) Chemical dependency professionals certified under chapter 18.205 RCW;
     (xvii) Sex offender treatment providers and certified affiliate sex offender treatment providers certified under chapter 18.155 RCW;
     (xviii) Persons licensed and certified under chapter 18.73 RCW or RCW 18.71.205;
     (xix) Denturists licensed under chapter 18.30 RCW;
     (xx) Orthotists and prosthetists licensed under chapter 18.200 RCW;
     (xxi) Surgical technologists registered under chapter 18.215 RCW;
     (xxii) Recreational therapists; and
     (xxiii) Animal massage practitioners certified under chapter 18.240 RCW.
     (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 quality assurance commission as established in chapter 18.25 RCW;
     (iii) The dental quality assurance commission as established in chapter 18.32 RCW governing licenses issued under chapter 18.32 RCW and licenses and registrations issued under chapter 18.260 RCW;
     (iv) The board of hearing and speech as established in chapter 18.35 RCW;
     (v) The board of examiners for nursing home administrators as established in chapter 18.52 RCW;
     (vi) The optometry board as established in chapter 18.54 RCW governing licenses issued under chapter 18.53 RCW;
     (vii) 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;
     (viii) The board of pharmacy as established in chapter 18.64 RCW governing licenses issued under chapters 18.64 and 18.64A RCW;
     (ix) ((The medical quality assurance commission as established in chapter 18.71 RCW governing licenses and registrations issued under chapters 18.71 and 18.71A RCW;
     (x))) The board of physical therapy as established in chapter 18.74 RCW;
     (((xi))) (x) The board of occupational therapy practice as established in chapter 18.59 RCW;
     (((xii))) (xi) The nursing care quality assurance commission as established in chapter 18.79 RCW governing licenses and registrations issued under that chapter;
     (((xiii))) (xii) The examining board of psychology and its disciplinary committee as established in chapter 18.83 RCW; and
     (((xiv))) (xiii) 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. 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.
     (4) All disciplining authorities shall adopt procedures to ensure substantially consistent application of this chapter, the Uniform Disciplinary Act, among the disciplining authorities listed in subsection (2) of this section.

Sec. 304   RCW 18.130.040 and 2007 c 269 s 17, 2007 c 253 s 13, and 2007 c 70 s 11 are each reenacted and 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 and designated apprentices 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 licensed under chapter 18.06 RCW;
     (viii) Radiologic technologists certified and X-ray technicians registered under chapter 18.84 RCW;
     (ix) Respiratory care practitioners licensed under chapter 18.89 RCW;
     (x) Persons registered under chapter 18.19 RCW;
     (xi) Persons licensed as mental health counselors, marriage and family therapists, and social workers under chapter 18.225 RCW;
     (xii) Persons registered as nursing pool operators under chapter 18.52C RCW;
     (xiii) Nursing assistants registered or certified under chapter 18.88A RCW;
     (xiv) Health care assistants certified under chapter 18.135 RCW;
     (xv) Dietitians and nutritionists certified under chapter 18.138 RCW;
     (xvi) Chemical dependency professionals certified under chapter 18.205 RCW;
     (xvii) Sex offender treatment providers and certified affiliate sex offender treatment providers certified under chapter 18.155 RCW;
     (xviii) Persons licensed and certified under chapter 18.73 RCW or RCW 18.71.205;
     (xix) Denturists licensed under chapter 18.30 RCW;
     (xx) Orthotists and prosthetists licensed under chapter 18.200 RCW;
     (xxi) Surgical technologists registered under chapter 18.215 RCW;
     (xxii) Recreational therapists;
     (xxiii) Animal massage practitioners certified under chapter 18.240 RCW; and
     (xxiv) Athletic trainers licensed under chapter 18.250 RCW.
     (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 quality assurance commission as established in chapter 18.25 RCW;
     (iii) The dental quality assurance commission as established in chapter 18.32 RCW governing licenses issued under chapter 18.32 RCW and licenses and registrations issued under chapter 18.260 RCW;
     (iv) The board of hearing and speech as established in chapter 18.35 RCW;
     (v) The board of examiners for nursing home administrators as established in chapter 18.52 RCW;
     (vi) The optometry board as established in chapter 18.54 RCW governing licenses issued under chapter 18.53 RCW;
     (vii) 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;
     (viii) The board of pharmacy as established in chapter 18.64 RCW governing licenses issued under chapters 18.64 and 18.64A RCW;
     (ix) ((The medical quality assurance commission as established in chapter 18.71 RCW governing licenses and registrations issued under chapters 18.71 and 18.71A RCW;
     (x))) The board of physical therapy as established in chapter 18.74 RCW;
     (((xi))) (x) The board of occupational therapy practice as established in chapter 18.59 RCW;
     (((xii))) (xi) The nursing care quality assurance commission as established in chapter 18.79 RCW governing licenses and registrations issued under that chapter;
     (((xiii))) (xii) The examining board of psychology and its disciplinary committee as established in chapter 18.83 RCW; and
     (((xiv))) (xiii) 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. 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.
     (4) All disciplining authorities shall adopt procedures to ensure substantially consistent application of this chapter, the Uniform Disciplinary Act, among the disciplining authorities listed in subsection (2) of this section.

Sec. 305   RCW 18.50.115 and 1994 sp.s. c 9 s 707 are each amended to read as follows:
     A midwife licensed under this chapter may obtain and administer prophylactic ophthalmic medication, postpartum oxytocic, vitamin K, Rho immune globulin (human), and local anesthetic and may administer such other drugs or medications as prescribed by a physician. A pharmacist who dispenses such drugs to a licensed midwife shall not be liable for any adverse reactions caused by any method of use by the midwife.
     The secretary, after consultation with representatives of the midwife advisory committee, the board of pharmacy, and the medical ((quality assurance commission)) board for safety and quality, may adopt rules that authorize licensed midwives to purchase and use legend drugs and devices in addition to the drugs authorized in this chapter.

Sec. 306   RCW 69.41.030 and 2003 c 142 s 3 and 2003 c 53 s 323 are each reenacted and amended to read as follows:
     (1) It shall be unlawful for any person to sell, deliver, or possess any legend drug except upon the order or prescription of a physician under chapter 18.71 RCW, an osteopathic physician and surgeon under chapter 18.57 RCW, an optometrist licensed under chapter 18.53 RCW who is certified by the optometry board under RCW 18.53.010, a dentist under chapter 18.32 RCW, a podiatric physician and surgeon under chapter 18.22 RCW, a veterinarian under chapter 18.92 RCW, a commissioned medical or dental officer in the United States armed forces or public health service in the discharge of his or her official duties, a duly licensed physician or dentist employed by the veterans administration in the discharge of his or her official duties, a registered nurse or advanced registered nurse practitioner under chapter 18.79 RCW when authorized by the nursing care quality assurance commission, an osteopathic physician assistant under chapter 18.57A RCW when authorized by the board of osteopathic medicine and surgery, a physician assistant under chapter 18.71A RCW when authorized by the medical ((quality assurance commission)) board for safety and quality, a physician licensed to practice medicine and surgery or a physician licensed to practice osteopathic medicine and surgery, a dentist licensed to practice dentistry, a podiatric physician and surgeon licensed to practice podiatric medicine and surgery, or a veterinarian licensed to practice veterinary medicine, in any province of Canada which shares a common border with the state of Washington or in any state of the United States: PROVIDED, HOWEVER, That the above provisions shall not apply to sale, delivery, or possession by drug wholesalers or drug manufacturers, or their agents or employees, or to any practitioner acting within the scope of his or her license, or to a common or contract carrier or warehouseman, or any employee thereof, whose possession of any legend drug is in the usual course of business or employment: PROVIDED FURTHER, That nothing in this chapter or chapter 18.64 RCW shall prevent a family planning clinic that is under contract with the department of social and health services from selling, delivering, possessing, and dispensing commercially prepackaged oral contraceptives prescribed by authorized, licensed health care practitioners.
     (2)(a) A violation of this section involving the sale, delivery, or possession with intent to sell or deliver is a class B felony punishable according to chapter 9A.20 RCW.
     (b) A violation of this section involving possession is a misdemeanor.

Sec. 307   RCW 69.45.010 and 1994 sp.s. c 9 s 738 are each amended to read as follows:
     The definitions in this section apply throughout this chapter.
     (1) "Board" means the board of pharmacy.
     (2) "Drug samples" means any federal food and drug administration approved controlled substance, legend drug, or products requiring prescriptions in this state, which is distributed at no charge to a practitioner by a manufacturer or a manufacturer's representative, exclusive of drugs under clinical investigations approved by the federal food and drug administration.
     (3) "Controlled substance" means a drug, substance, or immediate precursor of such drug or substance, so designated under or pursuant to chapter 69.50 RCW, the uniform controlled substances act.
     (4) "Deliver" or "delivery" means the actual, constructive, or attempted transfer from one person to another of a drug or device, whether or not there is an agency relationship.
     (5) "Dispense" means the interpretation of a prescription or order for a drug, biological, or device and, pursuant to that prescription or order, the proper selection, measuring, compounding, labeling, or packaging necessary to prepare that prescription or order for delivery.
     (6) "Distribute" means to deliver, other than by administering or dispensing, a legend drug.
     (7) "Legend drug" means any drug that is required by state law or by regulations of the board to be dispensed on prescription only or is restricted to use by practitioners only.
     (8) "Manufacturer" means a person or other entity engaged in the manufacture or distribution of drugs or devices, but does not include a manufacturer's representative.
     (9) "Person" means any individual, corporation, government or governmental subdivision or agency, business trust, estate, trust, partnership, association, or any other legal entity.
     (10) "Practitioner" means a physician under chapter 18.71 RCW, an osteopathic physician or an osteopathic physician and surgeon under chapter 18.57 RCW, a dentist under chapter 18.32 RCW, a podiatric physician and surgeon under chapter 18.22 RCW, a veterinarian under chapter 18.92 RCW, a pharmacist under chapter 18.64 RCW, a commissioned medical or dental officer in the United States armed forces or the public health service in the discharge of his or her official duties, a duly licensed physician or dentist employed by the veterans administration in the discharge of his or her official duties, a registered nurse or advanced registered nurse practitioner under chapter 18.79 RCW when authorized to prescribe by the nursing care quality assurance commission, an osteopathic physician assistant under chapter 18.57A RCW when authorized by the board of osteopathic medicine and surgery, or a physician assistant under chapter 18.71A RCW when authorized by the medical ((quality assurance commission)) board for safety and quality.
     (11) "Manufacturer's representative" means an agent or employee of a drug manufacturer who is authorized by the drug manufacturer to possess drug samples for the purpose of distribution in this state to appropriately authorized health care practitioners.
     (12) "Reasonable cause" means a state of facts found to exist that would warrant a reasonably intelligent and prudent person to believe that a person has violated state or federal drug laws or regulations.
     (13) "Department" means the department of health.
     (14) "Secretary" means the secretary of health or the secretary's designee.

Sec. 308   RCW 69.50.402 and 2003 c 53 s 338 are each amended to read as follows:
     (1) It is unlawful for any person:
     (a) Who is subject to Article III to distribute or dispense a controlled substance in violation of RCW 69.50.308;
     (b) Who is a registrant, to manufacture a controlled substance not authorized by his or her registration, or to distribute or dispense a controlled substance not authorized by his or her registration to another registrant or other authorized person;
     (c) Who is a practitioner, to prescribe, order, dispense, administer, supply, or give to any person:
     (i) Any amphetamine, including its salts, optical isomers, and salts of optical isomers classified as a schedule II controlled substance by the board of pharmacy pursuant to chapter 34.05 RCW; or
     (ii) Any nonnarcotic stimulant classified as a schedule II controlled substance and designated as a nonnarcotic stimulant by the board of pharmacy pursuant to chapter 34.05 RCW;
except for the treatment of narcolepsy or for the treatment of hyperkinesis, or for the treatment of drug-induced brain dysfunction, or for the treatment of epilepsy, or for the differential diagnostic psychiatric evaluation of depression, or for the treatment of depression shown to be refractory to other therapeutic modalities, or for the clinical investigation of the effects of such drugs or compounds, in which case an investigative protocol therefor shall have been submitted to and reviewed and approved by the state board of pharmacy before the investigation has been begun: PROVIDED, That the board of pharmacy, in consultation with the medical ((quality assurance commission)) board for safety and quality and the osteopathic disciplinary board, may establish by rule, pursuant to chapter 34.05 RCW, disease states or conditions in addition to those listed in this subsection for the treatment of which Schedule II nonnarcotic stimulants may be prescribed, ordered, dispensed, administered, supplied, or given to patients by practitioners: AND PROVIDED, FURTHER, That investigations by the board of pharmacy of abuse of prescriptive authority by physicians, licensed pursuant to chapter 18.71 RCW, pursuant to subsection (1)(c) of this section shall be done in consultation with the medical ((quality assurance commission)) board for safety and quality;
     (d) To refuse or fail to make, keep or furnish any record, notification, order form, statement, invoice, or information required under this chapter;
     (e) To refuse an entry into any premises for any inspection authorized by this chapter; or
     (f) Knowingly to keep or maintain any store, shop, warehouse, dwelling, building, vehicle, boat, aircraft, or other structure or place, which is resorted to by persons using controlled substances in violation of this chapter for the purpose of using these substances, or which is used for keeping or selling them in violation of this chapter.
     (2) Any person who violates this section is guilty of a class C felony and upon conviction may be imprisoned for not more than two years, fined not more than two thousand dollars, or both.

Sec. 309   RCW 69.51A.010 and 2007 c 371 s 3 are each amended to read as follows:
     The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.
     (1) "Designated provider" means a person who:
     (a) Is eighteen years of age or older;
     (b) Has been designated in writing by a patient to serve as a designated provider under this chapter;
     (c) Is prohibited from consuming marijuana obtained for the personal, medical use of the patient for whom the individual is acting as designated provider; and
     (d) Is the designated provider to only one patient at any one time.
     (2) "Medical use of marijuana" means the production, possession, or administration of marijuana, as defined in RCW 69.50.101(q), for the exclusive benefit of a qualifying patient in the treatment of his or her terminal or debilitating illness.
     (3) "Qualifying patient" means a person who:
     (a) Is a patient of a physician licensed under chapter 18.71 or 18.57 RCW;
     (b) Has been diagnosed by that physician as having a terminal or debilitating medical condition;
     (c) Is a resident of the state of Washington at the time of such diagnosis;
     (d) Has been advised by that physician about the risks and benefits of the medical use of marijuana; and
     (e) Has been advised by that physician that they may benefit from the medical use of marijuana.
     (4) "Terminal or debilitating medical condition" means:
     (a) Cancer, human immunodeficiency virus (HIV), multiple sclerosis, epilepsy or other seizure disorder, or spasticity disorders; or
     (b) Intractable pain, limited for the purpose of this chapter to mean pain unrelieved by standard medical treatments and medications; or
     (c) Glaucoma, either acute or chronic, limited for the purpose of this chapter to mean increased intraocular pressure unrelieved by standard treatments and medications; or
     (d) Crohn's disease with debilitating symptoms unrelieved by standard treatments or medications; or
     (e) Hepatitis C with debilitating nausea or intractable pain unrelieved by standard treatments or medications; or
     (f) Diseases, including anorexia, which result in nausea, vomiting, wasting, appetite loss, cramping, seizures, muscle spasms, or spasticity, when these symptoms are unrelieved by standard treatments or medications; or
     (g) Any other medical condition duly approved by the Washington state medical ((quality assurance commission)) board for safety and quality in consultation with the board of osteopathic medicine and surgery as directed in this chapter.
     (5) "Valid documentation" means:
     (a) A statement signed by a qualifying patient's physician, or a copy of the qualifying patient's pertinent medical records, which states that, in the physician's professional opinion, the patient may benefit from the medical use of marijuana;
     (b) Proof of identity such as a Washington state driver's license or identicard, as defined in RCW 46.20.035; and
     (c) A copy of the physician statement described in (a) of this subsection shall have the same force and effect as the signed original.

Sec. 310   RCW 69.51A.070 and 2007 c 371 s 7 are each amended to read as follows:
     The Washington state medical ((quality assurance commission)) board for safety and quality in consultation with the board of osteopathic medicine and surgery, or other appropriate agency as designated by the governor, shall accept for consideration petitions submitted to add terminal or debilitating conditions to those included in this chapter. In considering such petitions, the Washington state medical ((quality assurance commission)) board for safety and quality in consultation with the board of osteopathic medicine and surgery shall include public notice of, and an opportunity to comment in a public hearing upon, such petitions. The Washington state medical ((quality assurance commission)) board for safety and quality in consultation with the board of osteopathic medicine and surgery shall, after hearing, approve or deny such petitions within one hundred eighty days of submission. The approval or denial of such a petition shall be considered a final agency action, subject to judicial review.

Sec. 311   RCW 70.41.200 and 2007 c 261 s 3 are each amended to read as follows:
     (1) Every hospital shall maintain a coordinated quality improvement program for the improvement of the quality of health care services rendered to patients and the identification and prevention of medical malpractice. The program shall include at least the following:
     (a) The establishment of a quality improvement committee with the responsibility to review the services rendered in the hospital, both retrospectively and prospectively, in order to improve the quality of medical care of patients and to prevent medical malpractice. The committee shall oversee and coordinate the quality improvement and medical malpractice prevention program and shall ensure that information gathered pursuant to the program is used to review and to revise hospital policies and procedures;
     (b) A medical staff privileges sanction procedure through which credentials, physical and mental capacity, and competence in delivering health care services are periodically reviewed as part of an evaluation of staff privileges;
     (c) The periodic review of the credentials, physical and mental capacity, and competence in delivering health care services of all persons who are employed or associated with the hospital;
     (d) A procedure for the prompt resolution of grievances by patients or their representatives related to accidents, injuries, treatment, and other events that may result in claims of medical malpractice;
     (e) The maintenance and continuous collection of information concerning the hospital's experience with negative health care outcomes and incidents injurious to patients including health care-associated infections as defined in RCW 43.70.056, patient grievances, professional liability premiums, settlements, awards, costs incurred by the hospital for patient injury prevention, and safety improvement activities;
     (f) The maintenance of relevant and appropriate information gathered pursuant to (a) through (e) of this subsection concerning individual physicians within the physician's personnel or credential file maintained by the hospital;
     (g) Education programs dealing with quality improvement, patient safety, medication errors, injury prevention, infection control, staff responsibility to report professional misconduct, the legal aspects of patient care, improved communication with patients, and causes of malpractice claims for staff personnel engaged in patient care activities; and
     (h) Policies to ensure compliance with the reporting requirements of this section.
     (2) Any person who, in substantial good faith, provides information to further the purposes of the quality improvement and medical malpractice prevention program or who, in substantial good faith, participates on the quality improvement committee shall not be subject to an action for civil damages or other relief as a result of such activity. Any person or entity participating in a coordinated quality improvement program that, in substantial good faith, shares information or documents with one or more other programs, committees, or boards under subsection (8) of this section is not subject to an action for civil damages or other relief as a result of the activity. For the purposes of this section, sharing information is presumed to be in substantial good faith. However, the presumption may be rebutted upon a showing of clear, cogent, and convincing evidence that the information shared was knowingly false or deliberately misleading.
     (3) Information and documents, including complaints and incident reports, created specifically for, and collected and maintained by, a quality improvement committee are not subject to review or disclosure, except as provided in this section, or discovery or introduction into evidence in any civil action, and no person who was in attendance at a meeting of such committee or who participated in the creation, collection, or maintenance of information or documents specifically for the committee shall be permitted or required to testify in any civil action as to the content of such proceedings or the documents and information prepared specifically for the committee. This subsection does not preclude: (a) In any civil action, the discovery of the identity of persons involved in the medical care that is the basis of the civil action whose involvement was independent of any quality improvement activity; (b) in any civil action, the testimony of any person concerning the facts which form the basis for the institution of such proceedings of which the person had personal knowledge acquired independently of such proceedings; (c) in any civil action by a health care provider regarding the restriction or revocation of that individual's clinical or staff privileges, introduction into evidence information collected and maintained by quality improvement committees regarding such health care provider; (d) in any civil action, disclosure of the fact that staff privileges were terminated or restricted, including the specific restrictions imposed, if any and the reasons for the restrictions; or (e) in any civil action, discovery and introduction into evidence of the patient's medical records required by regulation of the department of health to be made regarding the care and treatment received.
     (4) Each quality improvement committee shall, on at least a semiannual basis, report to the governing board of the hospital in which the committee is located. The report shall review the quality improvement activities conducted by the committee, and any actions taken as a result of those activities.
     (5) The department of health shall adopt such rules as are deemed appropriate to effectuate the purposes of this section.
     (6) The medical ((quality assurance commission)) board for safety and quality or the board of osteopathic medicine and surgery, as appropriate, may review and audit the records of committee decisions in which a physician's privileges are terminated or restricted. Each hospital shall produce and make accessible to the commission or board the appropriate records and otherwise facilitate the review and audit. Information so gained shall not be subject to the discovery process and confidentiality shall be respected as required by subsection (3) of this section. Failure of a hospital to comply with this subsection is punishable by a civil penalty not to exceed two hundred fifty dollars.
     (7) The department, the joint commission on accreditation of health care organizations, and any other accrediting organization may review and audit the records of a quality improvement committee or peer review committee in connection with their inspection and review of hospitals. Information so obtained shall not be subject to the discovery process, and confidentiality shall be respected as required by subsection (3) of this section. Each hospital shall produce and make accessible to the department the appropriate records and otherwise facilitate the review and audit.
     (8) A coordinated quality improvement program may share information and documents, including complaints and incident reports, created specifically for, and collected and maintained by, a quality improvement committee or a peer review committee under RCW 4.24.250 with one or more other coordinated quality improvement programs maintained in accordance with this section or RCW 43.70.510, a quality assurance committee maintained in accordance with RCW 18.20.390 or 74.42.640, or a peer review committee under RCW 4.24.250, for the improvement of the quality of health care services rendered to patients and the identification and prevention of medical malpractice. The privacy protections of chapter 70.02 RCW and the federal health insurance portability and accountability act of 1996 and its implementing regulations apply to the sharing of individually identifiable patient information held by a coordinated quality improvement program. Any rules necessary to implement this section shall meet the requirements of applicable federal and state privacy laws. Information and documents disclosed by one coordinated quality improvement program to another coordinated quality improvement program or a peer review committee under RCW 4.24.250 and any information and documents created or maintained as a result of the sharing of information and documents shall not be subject to the discovery process and confidentiality shall be respected as required by subsection (3) of this section, RCW 18.20.390 (6) and (8), 74.42.640 (7) and (9), and 4.24.250.
     (9) A hospital that operates a nursing home as defined in RCW 18.51.010 may conduct quality improvement activities for both the hospital and the nursing home through a quality improvement committee under this section, and such activities shall be subject to the provisions of subsections (2) through (8) of this section.
     (10) Violation of this section shall not be considered negligence per se.

Sec. 312   RCW 70.41.200 and 2007 c 273 s 22 and 2007 c 261 s 3 are each reenacted and amended to read as follows:
     (1) Every hospital shall maintain a coordinated quality improvement program for the improvement of the quality of health care services rendered to patients and the identification and prevention of medical malpractice. The program shall include at least the following:
     (a) The establishment of a quality improvement committee with the responsibility to review the services rendered in the hospital, both retrospectively and prospectively, in order to improve the quality of medical care of patients and to prevent medical malpractice. The committee shall oversee and coordinate the quality improvement and medical malpractice prevention program and shall ensure that information gathered pursuant to the program is used to review and to revise hospital policies and procedures;
     (b) A medical staff privileges sanction procedure through which credentials, physical and mental capacity, and competence in delivering health care services are periodically reviewed as part of an evaluation of staff privileges;
     (c) The periodic review of the credentials, physical and mental capacity, and competence in delivering health care services of all persons who are employed or associated with the hospital;
     (d) A procedure for the prompt resolution of grievances by patients or their representatives related to accidents, injuries, treatment, and other events that may result in claims of medical malpractice;
     (e) The maintenance and continuous collection of information concerning the hospital's experience with negative health care outcomes and incidents injurious to patients including health care-associated infections as defined in RCW 43.70.056, patient grievances, professional liability premiums, settlements, awards, costs incurred by the hospital for patient injury prevention, and safety improvement activities;
     (f) The maintenance of relevant and appropriate information gathered pursuant to (a) through (e) of this subsection concerning individual physicians within the physician's personnel or credential file maintained by the hospital;
     (g) Education programs dealing with quality improvement, patient safety, medication errors, injury prevention, infection control, staff responsibility to report professional misconduct, the legal aspects of patient care, improved communication with patients, and causes of malpractice claims for staff personnel engaged in patient care activities; and
     (h) Policies to ensure compliance with the reporting requirements of this section.
     (2) Any person who, in substantial good faith, provides information to further the purposes of the quality improvement and medical malpractice prevention program or who, in substantial good faith, participates on the quality improvement committee shall not be subject to an action for civil damages or other relief as a result of such activity. Any person or entity participating in a coordinated quality improvement program that, in substantial good faith, shares information or documents with one or more other programs, committees, or boards under subsection (8) of this section is not subject to an action for civil damages or other relief as a result of the activity. For the purposes of this section, sharing information is presumed to be in substantial good faith. However, the presumption may be rebutted upon a showing of clear, cogent, and convincing evidence that the information shared was knowingly false or deliberately misleading.
     (3) Information and documents, including complaints and incident reports, created specifically for, and collected and maintained by, a quality improvement committee are not subject to review or disclosure, except as provided in this section, or discovery or introduction into evidence in any civil action, and no person who was in attendance at a meeting of such committee or who participated in the creation, collection, or maintenance of information or documents specifically for the committee shall be permitted or required to testify in any civil action as to the content of such proceedings or the documents and information prepared specifically for the committee. This subsection does not preclude: (a) In any civil action, the discovery of the identity of persons involved in the medical care that is the basis of the civil action whose involvement was independent of any quality improvement activity; (b) in any civil action, the testimony of any person concerning the facts which form the basis for the institution of such proceedings of which the person had personal knowledge acquired independently of such proceedings; (c) in any civil action by a health care provider regarding the restriction or revocation of that individual's clinical or staff privileges, introduction into evidence information collected and maintained by quality improvement committees regarding such health care provider; (d) in any civil action, disclosure of the fact that staff privileges were terminated or restricted, including the specific restrictions imposed, if any and the reasons for the restrictions; or (e) in any civil action, discovery and introduction into evidence of the patient's medical records required by regulation of the department of health to be made regarding the care and treatment received.
     (4) Each quality improvement committee shall, on at least a semiannual basis, report to the governing board of the hospital in which the committee is located. The report shall review the quality improvement activities conducted by the committee, and any actions taken as a result of those activities.
     (5) The department of health shall adopt such rules as are deemed appropriate to effectuate the purposes of this section.
     (6) The medical ((quality assurance commission)) board for safety and quality or the board of osteopathic medicine and surgery, as appropriate, may review and audit the records of committee decisions in which a physician's privileges are terminated or restricted. Each hospital shall produce and make accessible to the commission or board the appropriate records and otherwise facilitate the review and audit. Information so gained shall not be subject to the discovery process and confidentiality shall be respected as required by subsection (3) of this section. Failure of a hospital to comply with this subsection is punishable by a civil penalty not to exceed two hundred fifty dollars.
     (7) The department, the joint commission on accreditation of health care organizations, and any other accrediting organization may review and audit the records of a quality improvement committee or peer review committee in connection with their inspection and review of hospitals. Information so obtained shall not be subject to the discovery process, and confidentiality shall be respected as required by subsection (3) of this section. Each hospital shall produce and make accessible to the department the appropriate records and otherwise facilitate the review and audit.
     (8) A coordinated quality improvement program may share information and documents, including complaints and incident reports, created specifically for, and collected and maintained by, a quality improvement committee or a peer review committee under RCW 4.24.250 with one or more other coordinated quality improvement programs maintained in accordance with this section or RCW 43.70.510, a coordinated quality improvement committee maintained by an ambulatory surgical facility under RCW 70.230.070, a quality assurance committee maintained in accordance with RCW 18.20.390 or 74.42.640, or a peer review committee under RCW 4.24.250, for the improvement of the quality of health care services rendered to patients and the identification and prevention of medical malpractice. The privacy protections of chapter 70.02 RCW and the federal health insurance portability and accountability act of 1996 and its implementing regulations apply to the sharing of individually identifiable patient information held by a coordinated quality improvement program. Any rules necessary to implement this section shall meet the requirements of applicable federal and state privacy laws. Information and documents disclosed by one coordinated quality improvement program to another coordinated quality improvement program or a peer review committee under RCW 4.24.250 and any information and documents created or maintained as a result of the sharing of information and documents shall not be subject to the discovery process and confidentiality shall be respected as required by subsection (3) of this section, RCW 18.20.390 (6) and (8), 74.42.640 (7) and (9), and 4.24.250.
     (9) A hospital that operates a nursing home as defined in RCW 18.51.010 may conduct quality improvement activities for both the hospital and the nursing home through a quality improvement committee under this section, and such activities shall be subject to the provisions of subsections (2) through (8) of this section.
     (10) Violation of this section shall not be considered negligence per se.

Sec. 313   RCW 70.41.230 and 1994 sp.s. c 9 s 744 are each amended to read as follows:
     (1) Prior to granting or renewing clinical privileges or association of any physician or hiring a physician, a hospital or facility approved pursuant to this chapter shall request from the physician and the physician shall provide the following information:
     (a) The name of any hospital or facility with or at which the physician had or has any association, employment, privileges, or practice;
     (b) If such association, employment, privilege, or practice was discontinued, the reasons for its discontinuation;
     (c) Any pending professional medical misconduct proceedings or any pending medical malpractice actions in this state or another state, the substance of the allegations in the proceedings or actions, and any additional information concerning the proceedings or actions as the physician deems appropriate;
     (d) The substance of the findings in the actions or proceedings and any additional information concerning the actions or proceedings as the physician deems appropriate;
     (e) A waiver by the physician of any confidentiality provisions concerning the information required to be provided to hospitals pursuant to this subsection; and
     (f) A verification by the physician that the information provided by the physician is accurate and complete.
     (2) Prior to granting privileges or association to any physician or hiring a physician, a hospital or facility approved pursuant to this chapter shall request from any hospital with or at which the physician had or has privileges, was associated, or was employed, the following information concerning the physician:
     (a) Any pending professional medical misconduct proceedings or any pending medical malpractice actions, in this state or another state;
     (b) Any judgment or settlement of a medical malpractice action and any finding of professional misconduct in this state or another state by a licensing or disciplinary board; and
     (c) Any information required to be reported by hospitals pursuant to RCW 18.71.0195.
     (3) The medical ((quality assurance commission)) board for safety and quality shall be advised within thirty days of the name of any physician denied staff privileges, association, or employment on the basis of adverse findings under subsection (1) of this section.
     (4) A hospital or facility that receives a request for information from another hospital or facility pursuant to subsections (1) and (2) of this section shall provide such information concerning the physician in question to the extent such information is known to the hospital or facility receiving such a request, including the reasons for suspension, termination, or curtailment of employment or privileges at the hospital or facility. A hospital, facility, or other person providing such information in good faith is not liable in any civil action for the release of such information.
     (5) Information and documents, including complaints and incident reports, created specifically for, and collected, and maintained by a quality improvement committee are not subject to discovery or introduction into evidence in any civil action, and no person who was in attendance at a meeting of such committee or who participated in the creation, collection, or maintenance of information or documents specifically for the committee shall be permitted or required to testify in any civil action as to the content of such proceedings or the documents and information prepared specifically for the committee. This subsection does not preclude: (a) In any civil action, the discovery of the identity of persons involved in the medical care that is the basis of the civil action whose involvement was independent of any quality improvement activity; (b) in any civil action, the testimony of any person concerning the facts which form the basis for the institution of such proceedings of which the person had personal knowledge acquired independently of such proceedings; (c) in any civil action by a health care provider regarding the restriction or revocation of that individual's clinical or staff privileges, introduction into evidence information collected and maintained by quality improvement committees regarding such health care provider; (d) in any civil action, disclosure of the fact that staff privileges were terminated or restricted, including the specific restrictions imposed, if any and the reasons for the restrictions; or (e) in any civil action, discovery and introduction into evidence of the patient's medical records required by regulation of the department of health to be made regarding the care and treatment received.
     (6) Hospitals shall be granted access to information held by the medical ((quality assurance commission)) board for safety and quality and the board of osteopathic medicine and surgery pertinent to decisions of the hospital regarding credentialing and recredentialing of practitioners.
     (7) Violation of this section shall not be considered negligence per se.

Sec. 314   RCW 74.09.290 and 1994 sp.s. c 9 s 749 are each amended to read as follows:
     The secretary of the department of social and health services or his authorized representative shall have the authority to:
     (1) Conduct audits and investigations of providers of medical and other services furnished pursuant to this chapter, except that the Washington state medical ((quality assurance commission)) board for safety and quality shall generally serve in an advisory capacity to the secretary in the conduct of audits or investigations of physicians. Any overpayment discovered as a result of an audit of a provider under this authority shall be offset by any underpayments discovered in that same audit sample. In order to determine the provider's actual, usual, customary, or prevailing charges, the secretary may examine such random representative records as necessary to show accounts billed and accounts received except that in the conduct of such examinations, patient names, other than public assistance applicants or recipients, shall not be noted, copied, or otherwise made available to the department. In order to verify costs incurred by the department for treatment of public assistance applicants or recipients, the secretary may examine patient records or portions thereof in connection with services to such applicants or recipients rendered by a health care provider, notwithstanding the provisions of RCW 5.60.060, 18.53.200, 18.83.110, or any other statute which may make or purport to make such records privileged or confidential: PROVIDED, That no original patient records shall be removed from the premises of the health care provider, and that the disclosure of any records or information by the department of social and health services is prohibited and shall be punishable as a class C felony according to chapter 9A.20 RCW, unless such disclosure is directly connected to the official purpose for which the records or information were obtained: PROVIDED FURTHER, That the disclosure of patient information as required under this section shall not subject any physician or other health services provider to any liability for breach of any confidential relationship between the provider and the patient, but no evidence resulting from such disclosure may be used in any civil, administrative, or criminal proceeding against the patient unless a waiver of the applicable evidentiary privilege is obtained: PROVIDED FURTHER, That the secretary shall destroy all copies of patient medical records in their possession upon completion of the audit, investigation or proceedings;
     (2) Approve or deny applications to participate as a provider of services furnished pursuant to this chapter;
     (3) Terminate or suspend eligibility to participate as a provider of services furnished pursuant to this chapter; and
     (4) Adopt, promulgate, amend, and repeal administrative rules, in accordance with the Administrative Procedure Act, chapter 34.05 RCW, to carry out the policies and purposes of RCW 74.09.200 through 74.09.290.

Sec. 315   RCW 74.42.230 and 1994 sp.s. c 9 s 751 are each amended to read as follows:
     (1) The resident's attending or staff physician or authorized practitioner approved by the attending physician shall order all medications for the resident. The order may be oral or written and shall be limited by time. An "authorized practitioner," as used in this section, is a registered nurse under chapter 18.79 RCW when authorized by the nursing care quality assurance commission, an osteopathic physician assistant under chapter 18.57A RCW when authorized by the committee of osteopathic examiners, or a physician assistant under chapter 18.71A RCW when authorized by the medical ((quality assurance commission)) board for safety and quality.
     (2) An oral order shall be given only to a licensed nurse, pharmacist, or another physician. The oral order shall be recorded and signed immediately by the person receiving the order. The attending physician shall sign the record of the oral order in a manner consistent with good medical practice.

NEW SECTION.  Sec. 316   The following acts or parts of acts are each repealed:
     (1) RCW 18.71.401 (Funds collected -- Where deposited) and 1997 c 79 s 1; and
     (2) RCW 18.71.420 (Allocation of all appropriated funds) and 1991 c 3 s 171 & 1983 c 71 s 3.

NEW SECTION.  Sec. 317   If any provision of this act or its application to any person or circumstance is held invalid, the remainder of the act or the application of the provision to other persons or circumstances is not affected.

NEW SECTION.  Sec. 318   Sections 130 through 138 of this act are each added to chapter 18.71 RCW.

NEW SECTION.  Sec. 319   Sections 201 through 246 of this act constitute a new chapter in Title 18 RCW.

NEW SECTION.  Sec. 320   Part headings and subheadings used in this act are not any part of the law.

NEW SECTION.  Sec. 321   Sections 105, 109, 311, and 313 of this act expire July 1, 2009.

NEW SECTION.  Sec. 322   Sections 106, 110, 312, and 314 of this act take effect July 1, 2009.

NEW SECTION.  Sec. 323   Section 303 of this act expires July 1, 2008.

NEW SECTION.  Sec. 324   Section 304 of this act takes effect July 1, 2008.