Draft Rules Dec-2007

Mandatory Reporting Rules

Draft December 2007

Explanation:
The October 2007 draft has been revised as a result of stakeholder comments. Changes include:

Deleting the examples of unprofessional conduct. The examples worked for some professions but not all.

The focus of mandatory reports from corporations, associations and other entities has been narrowed to focus on patient harm.

Reports are required when there is actual knowledge.

Provisions related to immunity and public disclosure were omitted because those topics are defined by law.

Peer consultation groups are not considered professional associations for these rules.

Language was revised to comply with the Governor’s directive on plain talk.

Draft Rule Language:

WAC 246-16-200 Mandatory Reporting of unprofessional conduct or inability to practice with reasonable skill and safety.

This section requires reports of patient harm or unreasonable risk of harm to a patient by a health care provider. It is not intended to limit reports from any person who has concerns about a license holder’s conduct or ability to practice safely.

(1) Definitions in this section.

(a) "Approved impaired practitioner or voluntary substance abuse program" means a program authorized by RCW 18.130.175 and approved by a disciplining authority listed in RCW 18.130.040.

(b) "Conviction" means a court has decided a person is guilty of any gross misdemeanor or felony. It includes any guilty or no contest plea and all decisions with a deferred or suspended sentence.

(c) "Determination or finding" means a decision that a license holder has harmed a patient or has caused an unreasonable risk of harm to a patient. This applies even if no adverse action or sanction has been imposed or if the license holder is appealing the decision.

(d) "License holder" means a person holding a credential in a profession regulated by a disciplining authority listed in RCW 18.130.040(2).

(e) "Unable to practice with reasonable skill and safety due to a mental or physical condition" means a license holder:

(i) a court has declared to be incompetent or mentally ill, or

(ii) who is not successfully managing a mental or physical condition and is reasonably likely to cause harm to a patient or client.

(f) "Unprofessional conduct" means the acts, conduct, or conditions described in RCW 18.130.180.

(2) How to report.

(a) Reports are submitted to the department of health. The department will give the report to the appropriate disciplining authority for review, possible investigation, and further action.

(i) When a patient has been harmed, a report to the department is required. A report to one of the approved impaired practitioner or voluntary substance abuse programs is not a substitute for reporting to the department.

(ii) Reports to a national practitioner data bank do not meet the requirement of this section.

(b) The report must include enough information to enable the disciplining authority to assess the report. If these details are known, the report should include:

(i) The name, address, and telephone number of the person making the report.
(ii) The name, address, and telephone number(s) of the license holder being reported.
(iii) Identification of any patient or client who was harmed or placed at risk.
(iv) A brief description or summary of the facts that caused the report, including dates.
(v) If court action is involved, the name of the court, the date of filing, and the docket number.

(vi) Any other information that helps explain the situation.

(c) Reports must be submitted no later than thirty calendar days after the reporting person has actual knowledge of the situation.

(3) Each license holder must self report:

(a) Any conviction, determination, or finding that he or she has committed unprofessional conduct or is unable to practice with reasonable skill and safety due to a mental or physical condition; and

(b) Any determination that he or she is disqualified from participation in the federal Medicare or Medicaid program.

(4) A license holder must report another license holder in some circumstances.

(a) The reporting license holder must submit a report when he or she has actual knowledge of:

(i) Any conviction, determination, or finding that another license holder has committed an act that constitutes unprofessional conduct, and

(ii) That another license holder may not be able to practice his or her profession with reasonable skill and safety due to a mental or physical condition.

(b) The license holder does not have to report when he or she is:

(i) A member of a professional review organization as provided in subsection (7) of this section;

(ii) Providing health care to the other license holder and the other license holder does not pose a clear and present danger to patients or clients; or

(iii) Part of a federally funded substance abuse program or approved impaired practitioner or voluntary substance abuse program and the other license holder is participating in treatment and does not pose a clear and present danger to patients or clients.

(5) Reports by professional liability insurance carriers. Every institution, corporation or organization providing professional liability insurance directly or indirectly to a license holder must report:

(a) Any malpractice settlement, award, or payment in excess of twenty thousand dollars that results from a claim or action for damages allegedly caused by a license holder’s incompetence or negligence in the practice of the profession.

(b) Award, settlement, or payment of three or more claims during a twelve-month period that result from claims or actions for damages allegedly caused by the license holder's incompetence or negligence in the practice of the profession.

(6) Reports by health care institutions.

(a) This subsection applies to

(i) Hospitals and specialty hospital defined in chapter 70.41 RCW,

(ii) Ambulatory surgery centers defined in chapter 70.230 RCW,

(iii) Childbirth centers defined in chapter 18.46 RCW,

(iv) Nursing homes defined in chapter 18.51 RCW,

(v) Chemical dependency treatment programs defined in chapter 70.96A RCW,

(vi) Drug treatment agencies defined in chapter 69.54 RCW, and

(vii) Public and private mental health treatment agencies defined in RCW 71.05.020, and 71.24.025.

(b) The chief administrator or executive officer or designee of these institutions must report when:

(i) A license holder’s services are terminated or restricted because a license holder has harmed or placed at unreasonable risk of harm a patient or client, or
(ii) The institution believes a license holder poses an unreasonable risk of harm to patients or clients due to a mental or physical condition.

(7) Reports by professional associations and societies.

(a) Professional associations and societies include groups of health care providers organized at the state and national level. Peer consultation groups are not considered professional associations for purposes of mandatory reporting in this section.

(b) The president or chief executive officer of any health care profession association or society within Washington must report when:

(i) The association or society has determined a license holder has harmed or placed at unreasonable risk of harm a patient or client, or
(ii) The association or society has actual knowledge that a license holder poses an unreasonable risk of harm to patients because of a mental or physical condition.

(8) Service contractors and insurance carriers. The executive officer of insurance providers and health care service contractors licensed under title 48 RCW must report any decision that a license holder has engaged in billing fraud or has committed unprofessional conduct.

(9) Reports by professional review organizations.

(a) This section applies to every peer review committee, quality improvement committee, or other similarly designated professional review organization operating in the state of Washington.

(b) Unless prohibited by state or federal law, each professional review organization must report:

(i) When it determines a license holder has caused harm to a patient or placed a patient at unreasonable risk of harm, and

(ii) When it has actual knowledge that the license holder poses an unreasonable risk of harm due to a mental or physical condition.

(c) Professional review organizations and individual license holders participating in a professional review organization do not need to report during the investigative phase of the professional review organization’s operation if the organization completes the investigation in a timely manner.

(10) The department requests that the clerks of trial courts in Washington report professional malpractice judgments and all convictions against a license holder.

(11) The department requests that any state or federal program employing a license holder in Washington report:

(a) When it determines a license holder has harmed or placed at unreasonable risk of harm a patient or client, and

(b) When it has actual knowledge that the license holder poses an unreasonable risk of harm due to a mental or physical condition.