READ FIRST TIME 01/26/12.   

     AN ACT Relating to creating a career pathway for medical assistants; amending RCW 18.135.030, 18.135.040, 18.135.060, 18.135.070, 18.135.090, 18.135.110, 18.135.120, 18.120.020, 18.130.040, and 46.61.506; reenacting and amending RCW 18.135.020; adding new sections to chapter 18.135 RCW; creating a new section; and repealing RCW 18.135.010, 18.135.025, 18.135.050, 18.135.055, and 18.135.062.

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

NEW SECTION.  Sec. 1   The legislature finds that medical assistants are health care professionals who commonly work in ambulatory settings, such as physicians' offices, clinics, and group practices. Medical assistants are trained to perform administrative and clinical procedures as part of a health care team. Currently, medical assistants are not credentialed, although there is a nationally recognized certifying organization.
     The legislature further finds that health care assistants are currently credentialed in this state. Health care assistants are certified to perform very specific tasks such as blood draws, injections, limited medication administration, skin tests, and hemodialysis. The existence of these two professions, one with a commonly used title but no credential, the other with a credential but seldom used title, causes significant confusion for health care professionals.
     The legislature intends to change the designation of health care assistant to medical assistant. Rather than have multiple disparate categories for medical assistant certification, the legislature intends to provide minimum requirements for entry-level medical assistants and require the department of health to establish a career ladder so that medical assistants can, through experience and education, increase their skills and the procedures in which they are permitted to assist.

NEW SECTION.  Sec. 2   A new section is added to chapter 18.135 RCW to read as follows:
     (1) Medical assistants certified under this chapter have limited authority to perform certain delegated medical tasks related to administering basic first aid; collecting routine laboratory specimens; assisting with patient examinations or treatment; performing minor clinical procedures; operating office medical equipment; performing basic laboratory procedures; and administering medications by unit, single, or calculated dosage including vaccines.
     (2) The secretary shall create in rule:
     (a) Categories of medical assistants that may be authorized to perform the tasks in subsection (1) of this section. The categories must reflect an increasing level of skill and responsibility. The rules must also describe the training, experience, education, or examination requirements for each category;
     (b) One category of medical assistants must be for hemodialysis technicians. Rules adopted by the secretary must allow for the hemodialysis technician to be trained by the facility in which the person is employed so long as the training program is approved by the department. If the hemodialysis technician is so trained, he or she is not required to meet the requirements of section 4(3)(b) through (d) of this act; and
     (c) Training, experience, education, or examination requirements for entry-level health care workers to transition, via a career ladder, to medical assistants or for medical assistants to transition into other health care professions pursuant to RCW 18.135.030(2) (c) and (d).

Sec. 3   RCW 18.135.020 and 2009 c 43 s 4 are each reenacted and amended to read as follows:
     The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.
     (1) "Delegation" means direct authorization granted by a licensed health care practitioner to a ((health care)) medical assistant to perform the functions authorized in this chapter which fall within the scope of practice of the delegator and which are not within the scope of practice of the delegatee.
     (2) (("Health care assistant" means an unlicensed person who assists a licensed health care practitioner in providing health care to patients pursuant to this chapter. However, persons trained by a federally approved end-stage renal disease facility who perform end-stage renal dialysis in the home setting are exempt from certification under this chapter.)) "Department" means the department of health.
     (3) "Health care facility" means any hospital, hospice care center, licensed or certified health care facility, health maintenance organization regulated under chapter 48.46 RCW, federally qualified health maintenance organization, renal dialysis center or facility federally approved under 42 C.F.R. 405.2100, blood bank federally licensed under 21 C.F.R. 607, or clinical laboratory certified under 20 C.F.R. 405.1301-16.
     (4) "Health care practitioner" means:
     (a) A physician licensed under chapter 18.71 RCW;
     (b) An osteopathic physician or surgeon licensed under chapter 18.57 RCW; or
     (c) Acting within the scope of their respective licensure, a podiatric physician and surgeon licensed under chapter 18.22 RCW, a registered nurse or advanced registered nurse practitioner licensed under chapter 18.79 RCW, a naturopath licensed under chapter 18.36A RCW, a physician assistant licensed under chapter 18.71A RCW, or an osteopathic physician assistant licensed under chapter 18.57A RCW.
     (5) "Medical assistant" means a person certified under this chapter to assist a licensed health care practitioner in providing health care to patients. However, the term "medical assistant" does not include persons trained by a federally approved end-stage renal disease facility who perform end-stage renal dialysis in the home setting.
     (6) "Secretary" means the secretary of health.
     (((6))) (7) "Supervision" means supervision of procedures permitted pursuant to this chapter by a health care practitioner who is physically present and is immediately available in the facility during the administration of injections or vaccines, as defined in this chapter, or certain drugs as provided in RCW 18.135.130, but need not be present during procedures to withdraw blood.

NEW SECTION.  Sec. 4   A new section is added to chapter 18.135 RCW to read as follows:
     (1) Beginning July 1, 2014, no persons may represent themselves as medical assistants unless certified as provided for in this chapter. Once certified, medical assistants may only practice in the category of medical assistant for which they are certified. However, they may, under supervision of a health care professional, receive training for procedures in another category of medical assistant.
     (2) An applicant applying for certification as a medical assistant must file a written application on a form or forms provided by the secretary setting forth under affidavit such information as the secretary may require, and proof that the candidate has met qualifications set forth in this chapter.
     (3) Any person seeking certification as a medical assistant must meet the following qualifications:
     (a) Be eighteen years of age or older;
     (b) Have satisfactorily completed a medical assistant program approved by the secretary;
     (c) Have satisfactorily completed a medical assistant examination approved by the secretary; and
     (d) Demonstrate evidence of completing the education and training requirements for the category of medical assistant for which the person is seeking certification.

NEW SECTION.  Sec. 5   A new section is added to chapter 18.135 RCW to read as follows:
     (1) The secretary may certify a person as a medical assistant without examination if the person is licensed or certified as a medical assistant in another jurisdiction and if, in the secretary's judgment, the requirements of that jurisdiction are equivalent or greater than those of Washington state.
     (2) Before July 1, 2014, the secretary may certify as a medical assistant without examination if the person is practicing as a certified health care assistant and is in good standing. The secretary must certify the person for the category of medical assistant that is appropriate for the person's education and experience.

Sec. 6   RCW 18.135.030 and 1999 c 151 s 201 are each amended to read as follows:
     (1) The secretary or the secretary's designee may appoint members of the ((health care)) medical assistant profession and other health care practitioners, as defined in RCW 18.135.020(((3))), to serve in an ad hoc capacity to assist in carrying out the provisions of this chapter. The members shall provide advice on matters specifically identified and requested by the secretary. The members shall be reimbursed for travel expenses under RCW 43.03.050 and 43.03.060.
     (2) In addition to any other authority provided by law, the secretary shall:
     (a) Adopt rules necessary to((:
     (a))) administer, implement, and enforce this chapter, including rules providing for the transition of health care assistants to medical assistants and ensuring that a health care assistant practicing before July 1, 2014, will be certified in the appropriate medical assistant category for that person's education and experience;
     (b) Establish ((the minimum requirements necessary for a health care facility or health care practitioner to certify a health care assistant capable of performing the functions authorized in this chapter; and
     (c) Establish)) a career ladder permitting upward career advancement for medical assistants. The career ladder must consist of categories of medical assistants with minimum requirements for each and every category of ((health care)) medical assistant, including minimum requirements for the entry-level category, education and experience requirements that are needed for medical assistants to advance to another category, on-the-job instruction and training, and the procedures medical assistants are able to assist with during training to assist them in advancing up the ladder;
     (c) Establish requirements to assist entry-level health care workers in other fields, such as home care aides, to advance into a medical assistant position;
     (d) As part of the career ladder in (b) of this subsection, establish education and experience requirements to assist medical assistants to move into other health care professions, including nursing professions, that would benefit from their experience and training;
     (e) Establish forms necessary to administer this chapter, including forms medical assistants may use to document their education and experience;
     (f) Issue a certificate to an applicant who has met the requirements for certification and deny a certificate to an applicant who does not meet the minimum qualifications;
     (g) Hire clerical, administrative, and investigative staff as needed to implement this chapter and hire individuals, including those certified under this chapter, to serve as consultants as necessary to implement and administer this chapter;
     (h) Maintain the official department record of all applicants and certificate holders;
     (i) Conduct a hearing, under chapter 34.05 RCW, on an appeal of a denial of certification based on the applicant's failure to meet the minimum qualification for certification;
     (j) Investigate alleged violations of this chapter and consumer complaints involving the practice of persons representing themselves as medical assistants;
     (k) Issue subpoenas, statements of charges, statements of intent to deny certifications, and orders and delegate in writing to a designee the authority to issue subpoenas, statements of charges, and statement on intent to deny certifications;
     (l) Conduct disciplinary proceedings, impose sanctions, and assess fines for violations of this chapter or any rules adopted under it in accordance with chapter 34.05 RCW;
     (m) Set all certification, renewal, and late renewal fees;
     (n) Set certification expiration dates and renewal periods for all certifications under this chapter; and
     (o) Set minimum continuing education requirements.
     (3) ((The rules shall be adopted after fair consideration of input from representatives of each category. These requirements shall ensure that the public health and welfare are protected and shall include, but not be limited to, the following factors:
     (a) The education and occupational qualifications for the health care assistant category;
     (b) The work experience for the health care assistant category;
     (c) The instruction and training provided for the health care assistant category; and
     (d) The types of drugs or diagnostic agents which may be administered by injection by health care assistants working in a hospital or nursing home. The rules established under this subsection shall not prohibit health care assistants working in a health care facility other than a nursing home or hospital from performing the functions authorized under this chapter.)) Before adopting rules under this section and by December 1, 2012, the secretary must submit a preliminary plan, as described in this subsection, to the appropriate committees of the legislature. The preliminary plan must include the categories of medical assistants to be adopted in rule as well as the scope of practice of each category. The preliminary plan must also include the plan for transitioning health care assistants to medical assistants with a description of categories of health care assistants as they transition to categories of medical assistants.

Sec. 7   RCW 18.135.040 and 2006 c 242 s 3 are each amended to read as follows:
     A certification issued to a ((health care)) medical assistant pursuant to this chapter shall be authority to perform only the functions authorized ((in RCW 18.135.010)) for the category in which the medical assistant has been certified and subject to proper delegation and supervision in ((the)) a health care facility ((making the certification)) or under the supervision of ((the certifying)) a health care practitioner ((in other health care facilities or in his or her office or in the residences of research study participants in accordance with RCW 18.135.110. No certification made by one health care facility or health care practitioner is transferrable to another health care facility or health care practitioner)). Medical assistants may be trained in procedures in a category in which the medical assistant is not certified under the supervision of a health care professional.

Sec. 8   RCW 18.135.060 and 2001 c 22 s 3 are each amended to read as follows:
     (1) Except as provided in subsection (2) of this section:
     (a) Any ((health care)) medical assistant certified pursuant to this chapter shall perform the functions authorized in this chapter only by delegation of authority from ((the)) a health care practitioner and under the supervision of a health care practitioner acting within the scope of his or her license. In the case of subcutaneous, intradermal and intramuscular and intravenous injections, a ((health care)) medical assistant may perform such functions only under the supervision of a health care practitioner having authority, within the scope of his or her license, to order such procedures.
     (b) The health care practitioner who ordered the procedure or a health care practitioner who could order the procedure under his or her license shall be physically present in the immediate area of a hospital or nursing home where the injection is administered. Sensitivity agents being administered intradermally or by the scratch method are excluded from this requirement.
     (2) A ((health care)) medical assistant trained by a federally approved end-stage renal disease facility may perform venipuncture for blood withdrawal, administration of oxygen as necessary by cannula or mask, venipuncture for placement of fistula needles, connect to vascular catheter for hemodialysis, intravenous administration of heparin and sodium chloride solutions as an integral part of dialysis treatment, and intradermal, subcutaneous, or topical administration of local anesthetics in conjunction with placement of fistula needles, and intraperitoneal administration of sterile electrolyte solutions and heparin for peritoneal dialysis: (a) In the center or health care facility if a registered nurse licensed under chapter 18.79 RCW is physically present and immediately available in such center or health care facility; or (b) in the patient's home if a physician and a registered nurse are available for consultation during the dialysis.

Sec. 9   RCW 18.135.070 and 1993 c 367 s 11 are each amended to read as follows:
     The licensing authority of health care facilities or the disciplining authority of the delegating or supervising health care practitioner shall investigate all complaints or allegations of ((violations of proper certification of a health care assistant or)) violations of delegation of authority or supervision. A substantiated violation shall constitute sufficient cause for disciplinary action by the licensing authority of a health care facility or the disciplining authority of the health care practitioner.

Sec. 10   RCW 18.135.090 and 1984 c 281 s 9 are each amended to read as follows:
     The performance of the functions authorized in this chapter by a ((health care)) medical assistant pursuant to this chapter does not constitute unlicensed practice as a health care practitioner.

Sec. 11   RCW 18.135.110 and 2006 c 242 s 2 are each amended to read as follows:
     This chapter does not prohibit or restrict the performance of blood-drawing procedures by ((health care)) medical assistants in the residences of research study participants when such procedures have been authorized by the institutional review board of a comprehensive cancer center or nonprofit degree-granting institution of higher education and are conducted under the general supervision of a physician.

Sec. 12   RCW 18.135.120 and 2008 c 58 s 4 are each amended to read as follows:
     The administration of vaccines by a ((health care)) medical assistant is restricted to vaccines that are administered by injection, orally, or topically, including nasal administration, and that are licensed by the United States food and drug administration.

Sec. 13   RCW 18.120.020 and 2010 c 286 s 14 are each amended to read as follows:
     The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.
     (1) "Applicant group" includes any health professional group or organization, any individual, or any other interested party which proposes that any health professional group not presently regulated be regulated or which proposes to substantially increase the scope of practice of the profession.
     (2) "Certificate" and "certification" mean a voluntary process by which a statutory regulatory entity grants recognition to an individual who (a) has met certain prerequisite qualifications specified by that regulatory entity, and (b) may assume or use "certified" in the title or designation to perform prescribed health professional tasks.
     (3) "Grandfather clause" means a provision in a regulatory statute applicable to practitioners actively engaged in the regulated health profession prior to the effective date of the regulatory statute which exempts the practitioners from meeting the prerequisite qualifications set forth in the regulatory statute to perform prescribed occupational tasks.
     (4) "Health professions" means and includes the following health and health-related licensed or regulated professions and occupations: Podiatric medicine and surgery under chapter 18.22 RCW; chiropractic under chapter 18.25 RCW; dental hygiene under chapter 18.29 RCW; dentistry under chapter 18.32 RCW; denturism under chapter 18.30 RCW; dispensing opticians under chapter 18.34 RCW; hearing instruments under chapter 18.35 RCW; naturopaths under chapter 18.36A RCW; embalming and funeral directing under chapter 18.39 RCW; midwifery under chapter 18.50 RCW; nursing home administration under chapter 18.52 RCW; optometry under chapters 18.53 and 18.54 RCW; ocularists under chapter 18.55 RCW; osteopathic medicine and surgery under chapters 18.57 and 18.57A RCW; pharmacy under chapters 18.64 and 18.64A RCW; medicine under chapters 18.71 and 18.71A RCW; emergency medicine under chapter 18.73 RCW; physical therapy under chapter 18.74 RCW; practical nurses under chapter 18.79 RCW; psychologists under chapter 18.83 RCW; registered nurses under chapter 18.79 RCW; occupational therapists licensed under chapter 18.59 RCW; respiratory care practitioners licensed under chapter 18.89 RCW; veterinarians and veterinary technicians under chapter 18.92 RCW; ((health care)) medical assistants under chapter 18.135 RCW; massage practitioners under chapter 18.108 RCW; East Asian medicine practitioners licensed under chapter 18.06 RCW; persons registered under chapter 18.19 RCW; persons licensed as mental health counselors, marriage and family therapists, and social workers under chapter 18.225 RCW; dietitians and nutritionists certified by chapter 18.138 RCW; radiologic technicians under chapter 18.84 RCW; and nursing assistants registered or certified under chapter 18.88A RCW.
     (5) "Inspection" means the periodic examination of practitioners by a state agency in order to ascertain whether the practitioners' occupation is being carried out in a fashion consistent with the public health, safety, and welfare.
     (6) "Legislative committees of reference" means the standing legislative committees designated by the respective rules committees of the senate and house of representatives to consider proposed legislation to regulate health professions not previously regulated.
     (7) "License," "licensing," and "licensure" mean permission to engage in a health profession which would otherwise be unlawful in the state in the absence of the permission. A license is granted to those individuals who meet prerequisite qualifications to perform prescribed health professional tasks and for the use of a particular title.
     (8) "Professional license" means an individual, nontransferable authorization to carry on a health activity based on qualifications which include: (a) Graduation from an accredited or approved program, and (b) acceptable performance on a qualifying examination or series of examinations.
     (9) "Practitioner" means an individual who (a) has achieved knowledge and skill by practice, and (b) is actively engaged in a specified health profession.
     (10) "Public member" means an individual who is not, and never was, a member of the health profession being regulated or the spouse of a member, or an individual who does not have and never has had a material financial interest in either the rendering of the health professional service being regulated or an activity directly related to the profession being regulated.
     (11) "Registration" means the formal notification which, prior to rendering services, a practitioner shall submit to a state agency setting forth the name and address of the practitioner; the location, nature and operation of the health activity to be practiced; and, if required by the regulatory entity, a description of the service to be provided.
     (12) "Regulatory entity" means any board, commission, agency, division, or other unit or subunit of state government which regulates one or more professions, occupations, industries, businesses, or other endeavors in this state.
     (13) "State agency" includes every state office, department, board, commission, regulatory entity, and agency of the state, and, where provided by law, programs and activities involving less than the full responsibility of a state agency.

Sec. 14   RCW 18.130.040 and 2011 c 41 s 11 are each amended to read as follows:
     (1) This chapter applies only to the secretary and the boards and commissions having jurisdiction in relation to the professions licensed under the chapters specified in this section. This chapter does not apply to any business or profession not licensed under the chapters specified in this section.
     (2)(a) The secretary has authority under this chapter in relation to the following professions:
     (i) Dispensing opticians licensed and designated apprentices under chapter 18.34 RCW;
     (ii) Midwives licensed under chapter 18.50 RCW;
     (iii) Ocularists licensed under chapter 18.55 RCW;
     (iv) Massage operators and businesses licensed under chapter 18.108 RCW;
     (v) Dental hygienists licensed under chapter 18.29 RCW;
     (vi) East Asian medicine practitioners licensed under chapter 18.06 RCW;
     (vii) Radiologic technologists certified and X-ray technicians registered under chapter 18.84 RCW;
     (viii) Respiratory care practitioners licensed under chapter 18.89 RCW;
     (ix) Hypnotherapists and agency affiliated counselors registered and advisors and counselors certified under chapter 18.19 RCW;
     (x) Persons licensed as mental health counselors, mental health counselor associates, marriage and family therapists, marriage and family therapist associates, social workers, social work associates -- advanced, and social work associates -- independent clinical under chapter 18.225 RCW;
     (xi) Persons registered as nursing pool operators under chapter 18.52C RCW;
     (xii) Nursing assistants registered or certified under chapter 18.88A RCW;
     (xiii) ((Health care)) Medical assistants certified under chapter 18.135 RCW;
     (xiv) Dietitians and nutritionists certified under chapter 18.138 RCW;
     (xv) Chemical dependency professionals and chemical dependency professional trainees certified under chapter 18.205 RCW;
     (xvi) Sex offender treatment providers and certified affiliate sex offender treatment providers certified under chapter 18.155 RCW;
     (xvii) Persons licensed and certified under chapter 18.73 RCW or RCW 18.71.205;
     (xviii) Denturists licensed under chapter 18.30 RCW;
     (xix) Orthotists and prosthetists licensed under chapter 18.200 RCW;
     (xx) Surgical technologists registered under chapter 18.215 RCW;
     (xxi) Recreational therapists (([under chapter 18.230 RCW])) under chapter 18.230 RCW;
     (xxii) Animal massage practitioners certified under chapter 18.240 RCW;
     (xxiii) Athletic trainers licensed under chapter 18.250 RCW;
     (xxiv) Home care aides certified under chapter 18.88B RCW; and
     (xxv) Genetic counselors licensed under chapter 18.290 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) The board of occupational therapy practice as established in chapter 18.59 RCW;
     (xii) The nursing care quality assurance commission as established in chapter 18.79 RCW governing licenses and registrations issued under that chapter;
     (xiii) The examining board of psychology and its disciplinary committee as established in chapter 18.83 RCW;
     (xiv) The veterinary board of governors as established in chapter 18.92 RCW; and
     (xv) The board of naturopathy established in chapter 18.36A RCW.
     (3) In addition to the authority to discipline license holders, the disciplining authority has the authority to grant or deny licenses. The disciplining authority may also grant a license subject to conditions.
     (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. 15   RCW 46.61.506 and 2010 c 53 s 1 are each amended to read as follows:
     (1) Upon the trial of any civil or criminal action or proceeding arising out of acts alleged to have been committed by any person while driving or in actual physical control of a vehicle while under the influence of intoxicating liquor or any drug, if the person's alcohol concentration is less than 0.08, it is evidence that may be considered with other competent evidence in determining whether the person was under the influence of intoxicating liquor or any drug.
     (2) The breath analysis shall be based upon grams of alcohol per two hundred ten liters of breath. The foregoing provisions of this section shall not be construed as limiting the introduction of any other competent evidence bearing upon the question whether the person was under the influence of intoxicating liquor or any drug.
     (3) Analysis of the person's blood or breath to be considered valid under the provisions of this section or RCW 46.61.502 or 46.61.504 shall have been performed according to methods approved by the state toxicologist and by an individual possessing a valid permit issued by the state toxicologist for this purpose. The state toxicologist is directed to approve satisfactory techniques or methods, to supervise the examination of individuals to ascertain their qualifications and competence to conduct such analyses, and to issue permits which shall be subject to termination or revocation at the discretion of the state toxicologist.
     (4)(a) A breath test performed by any instrument approved by the state toxicologist shall be admissible at trial or in an administrative proceeding if the prosecution or department produces prima facie evidence of the following:
     (i) The person who performed the test was authorized to perform such test by the state toxicologist;
     (ii) The person being tested did not vomit or have anything to eat, drink, or smoke for at least fifteen minutes prior to administration of the test;
     (iii) The person being tested did not have any foreign substances, not to include dental work, fixed or removable, in his or her mouth at the beginning of the fifteen-minute observation period;
     (iv) Prior to the start of the test, the temperature of any liquid simulator solution utilized as an external standard, as measured by a thermometer approved of by the state toxicologist was thirty-four degrees centigrade plus or minus 0.3 degrees centigrade;
     (v) The internal standard test resulted in the message "verified";
     (vi) The two breath samples agree to within plus or minus ten percent of their mean to be determined by the method approved by the state toxicologist;
     (vii) The result of the test of the liquid simulator solution external standard or dry gas external standard result did lie between .072 to .088 inclusive; and
     (viii) All blank tests gave results of .000.
     (b) For purposes of this section, "prima facie evidence" is evidence of sufficient circumstances that would support a logical and reasonable inference of the facts sought to be proved. In assessing whether there is sufficient evidence of the foundational facts, the court or administrative tribunal is to assume the truth of the prosecution's or department's evidence and all reasonable inferences from it in a light most favorable to the prosecution or department.
     (c) Nothing in this section shall be deemed to prevent the subject of the test from challenging the reliability or accuracy of the test, the reliability or functioning of the instrument, or any maintenance procedures. Such challenges, however, shall not preclude the admissibility of the test once the prosecution or department has made a prima facie showing of the requirements contained in (a) of this subsection. Instead, such challenges may be considered by the trier of fact in determining what weight to give to the test result.
     (5) When a blood test is administered under the provisions of RCW 46.20.308, the withdrawal of blood for the purpose of determining its alcoholic or drug content may be performed only by a physician, a registered nurse, a licensed practical nurse, a nursing assistant as defined in chapter 18.88A RCW, a physician assistant as defined in chapter 18.71A RCW, a first responder as defined in chapter 18.73 RCW, an emergency medical technician as defined in chapter 18.73 RCW, a ((health care)) medical assistant as defined in chapter 18.135 RCW, or any technician trained in withdrawing blood. This limitation shall not apply to the taking of breath specimens.
     (6) The person tested may have a physician, or a qualified technician, chemist, registered nurse, or other qualified person of his or her own choosing administer one or more tests in addition to any administered at the direction of a law enforcement officer. The test will be admissible if the person establishes the general acceptability of the testing technique or method. The failure or inability to obtain an additional test by a person shall not preclude the admission of evidence relating to the test or tests taken at the direction of a law enforcement officer.
     (7) Upon the request of the person who shall submit to a test or tests at the request of a law enforcement officer, full information concerning the test or tests shall be made available to him or her or his or her attorney.

NEW SECTION.  Sec. 16   The following acts or parts of acts are each repealed:
     (1) RCW 18.135.010 (Practices authorized) and 2009 c 43 s 2, 2008 c 58 s 1, & 1984 c 281 s 1;
     (2) RCW 18.135.025 (Rules -- Legislative intent) and 1986 c 216 s 1;
     (3) RCW 18.135.050 (Certification by health care facility or practitioner -- Roster -- Recertification) and 1996 c 191 s 82, 1991 c 3 s 274, & 1984 c 281 s 5;
     (4) RCW 18.135.055 (Registering an initial or continuing certification -- Fees) and 1996 c 191 s 83, 1991 c 3 s 275, & 1985 c 117 s 1; and
     (5) RCW 18.135.062 (Renal dialysis training task force -- Development of core competencies) and 2001 c 22 s 4.