Profession • NO SOA/STID SOC/AO C&D SANCTIONS WORKSHEET teCCfie 'Q!i-WoM\.ffYaO Case Specifics Respondent Case Number Conduct (bnefly summanze) w ^ I B 1 2 30 least A B V greatest (OO Select the appropriate Sanction Schedule or Schedules (If multiple violations are mvolved a smgle worksheet is used, but multiple seventy tiers identified) Practice Below The Standard Of Care (WAG 246 1 6 810) 4 • Diversion (WAG 246-16 840) Sexual Misconduct or Contact (WAG 246-16 820) 5 • Substance Abuse (WAG 246 1 6 850) Abuse Physical and/Or Emotional (WAG 246 1 6 830) 6 C Criminal Convictions (WAG 246 1 6-860) 7 I None of the Above Circle the appropriate Tier of the Sanction Schedule Seventy Tier A SUMMARY C Sanction Range In consideration of Agsravating & Mitigatrng Gircumstances Maximum Mmunum Oversight for 3* or 5* years which Gonditions that may may mclude reprunand trammg, mclude reprimand, monitormg supe rvision, trammg moni tormg, evaluation, probation, suspension supervision, probation, evaluation, etc etc Oversight 2 years which Oversight for 5* or 7* years which may mclude suspension may mclude suspension probation, probation, practice practice restrictions, training, restrictions, trammg, monitormg, supervision monitonng, supervision, evaluation etc OR Revocation probation, evaluation etc Refer to Individual Sanction Schedules Refer to Individual Sanction Schedules Duration •Schedules 1 , 2,3 •Schedules4, 5,6 0 - 3 years 0 - 5 years •Schedules 1 ,2 ,3 , 6 2 - 5 years •Schedules 4, 5 2 - 7 years Unless Revocaton • Schedule 1 3 years - Permanent • Schedules 2, 3 4, 5 5 years - Permanent ' Schedule 6 6 years - Permanent (Always start in the middle of the range, and move along the spectrum with aggravatmg/mitigatmg cucumstances) D Prior disciplinary history or other related violation (bnefly descnbe) E WAC 246-16-890 Sanctions Aggravating and Mitigating Factors (Indicate which, and check all that apply) 4 Gene ral Factors I Related to Misconduct 2 Related to License Holder 3 Related to Disciplinary Process • Knowledge mtent, Q Admission of facts Q Experience m practice • Gravity of the misconduct And responsibility • Presence of pattern l~l Past disciplinary record Q Full and free disclosure to rn Age, Capacity, Vulnerabihty Of pat ient, client, victim (seen above) Disciplmmg authority • Present moral fitness • Number or frequency of acts • Previous character n Voluntary resntution or other remedial action • Potential for O Bad faith obstruction of O Injury caused by misconduct • Mental, physical health Successful rehabilitation mvestigation n Present competence l~l Personal circumstances • False evidence, statements, or O Potential for mjuiy To practice deceptive practices G Dishonest or selfish Q Degree of responsibility for O Personal problems havmg Q Remorse or awareness conduct Motives was wrong outcome A nexus with misconduct r i Impact on client patient, victim • Illegal conduct • Abuse of trust • Hemousness O Intentional or madvertent act • 111 repute upon • OTHER n Motivation is cnminal, Profession dishonest or for personal gam G Isolated mcident O Length of tune smce misconduct CASCADE BEHAVIORAL HOSPITAL 2017-5118FS PAGE 1 Profession • NOD • SOA/STID • C&D • CORE SANCTlQiNfS^ fCheck applicable sanctions^ Q Compliance with conditions (condiDons identified below) SOC/AO • SUMMARY I Q Probation with conditions (conditions identified beiow) O Suspension Q with no nght to petition for reinstatement for Q for indefinite term (months/years) O Revocation • for (months/years) with no nght to reapply during that time Q may petition for reinstatement after (months/years^ after providing evidence ofmeeting conditions indicated below Q Permanent (Ifseeking permanent revocation m ust prove no ability to rehabilitate) D Practice with restriction or limitations mdicated below Q Censure or Repnmand (circle one) (note Reprimand must be done with an SOC) D Payment of fine / cost recovery $ within months/years D Refund of fees collected from consumer proof of refund provided within months/years D Denial of credential application O Grant credential application with conditions indicated below CONDmOiXS D Approved supervisor for (months/years) Requirements for supervisor (e g credential or cxpenence) D Specific practice limitations or restrictions (eg no solo practice limitation on patient population chaperone) Explam D Employment restnctions (e g to certain practice settmgs or facilities) Explain n Reports from respondent/employer/supervisor/health care provider (circle one) for Report frequency • Evaluation (e g substance abuse momtonng anger management) within G Comply with coursework/treatment recommendations months^cars (cu-cle one) months/years Explain • Momtormg program (e g Washmgton Recovery and Monitoring Program (WRAMP) W ashington Recovery Assistance Program for Pharmacy (WRAPP) Washington Physicians Health Program (WPHP) and comply with contract (sole condition related to substance abuse) D Biological fluid testing (do not use if sanction includes monitoring program) n Practice review/audits Revicw/audit is to assess n Proctormg/Preceptorship for Explain (number) of audits over months/vears (months/years) O Notification of employer/patient D Return credential in association with indefinite suspension or revocation n Continuing education Type and hours (Respondent may not engage in the subject activity until CE is completed at a minimum) Deadline for completion n Skills assessment Deadline for completion /Mimical trainirg/re&csher course Details , . WW OAJCVKHS. Oojnpleted by Peggy Owen Date . -i /> / ^ ( u ta r. OjC^pWlWL D CASCADE BEHAVIORAL HOSPITAL 2017-5118FS PAGE 2 LEGAL REVIEW - ABSTRACT RESPONDENT Cascade Behavioral Hospital (HPSY PS 60429197) CASE NUMBER 2017 511 8 SHORT RECOMMENDATION 1 - Attorney Work Product - RCW 42.56.290 - Drafts, notes, memoranda, statements, records or research reflecting the o... 1 - Attorney Work Product - RCW 42.56.290 - Drafts, notes, memoranda... ALLEGATIONS Psychiatric hospital is i n violation of state laws and rules ANALYSIS 1 - Attorney Work Product - RCW 42.56.290 - Drafts, notes, memoranda, statements, records or research reflecting the opinions or mental impressions of an attorney or attorney’s ag CASCADE BEHAVIORAL HOSPITAL 2017-5118FS PAGE 3