BILL REQUEST - CODE REVISER'S OFFICE

BILL REQ. #:

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ATTY/TYPIST:

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BRIEF DESCRIPTION:

Protecting patient safety in psychiatric
hospitals and other health care facilities.

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AN ACT Relating to protecting patient safety in psychiatric
hospitals and other health care facilities regulated by the
department
of
health
through
improvements
to
licensing
and
enforcement; amending RCW 71.12.460, 71.12.470, 71.12.480, and
71.12.500; reenacting and amending RCW 71.12.455; adding new sections
to chapter 43.70 RCW; adding new sections to chapter 71.12 RCW;
creating a new section; and declaring an emergency.

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

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NEW SECTION.
Sec. 1.
The legislature finds that current
regulatory oversight of psychiatric hospitals licensed under chapter
71.12 RCW is insufficient to protect the health, safety, and wellbeing of patients seeking behavioral health care in these facilities.
Several hospitals have failed to comply with state licensing
requirements for extended periods of time leaving patients at risk.
Additional enforcement tools are needed to address noncompliance and
protect patients from risk of harm.
The legislature also finds that licensing and enforcement
requirements for all health care facility types regulated by the
department of health are inconsistent. Review of the regulatory
requirements for all health care facility types, including acute care
hospitals, is needed to identify gaps and opportunities to
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consolidate and standardize requirements. Legislation will be
necessary to implement uniform requirements that assure provision of
safe, quality care and create consistency and predictability for
facilities.

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NEW SECTION.
Sec. 2.
A new section is added to chapter 43.70
RCW to read as follows:
(1) In any case in which the department finds that a psychiatric
hospital licensed or provisionally licensed under chapter 71.12 RCW
has failed or refused to comply with applicable state statutes or
regulations, the department may take one or more of the following
actions:
(a) Refuse to issue a license;
(b) Impose reasonable conditions on a license, including but not
limited to correction within a specified time, training, or requiring
the facility to hire a department-approved consultant;

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(c) In accordance with RCW 43.70.095, impose civil fines of at
least ten thousand dollars per violation, not to exceed a total fine
of one million dollars. Fines may only be used by the department for
provision of technical assistance to psychiatric hospitals and to
offset the cost of psychiatric hospital licensing activities;
(d) In accordance with RCW 43.70.095, impose civil fines of up to
ten thousand dollars for each day a person operates a psychiatric
hospital without a valid license. Fines may only be used by the
department for provision of technical assistance, as defined in RCW
71.12.455, to psychiatric hospitals and to offset the cost of
psychiatric hospital licensing activities;
(e) Suspend, revoke, or refuse to renew a license;
(f) Suspend new admissions to the facility by immediately
imposing a stop placement; or
(g) Suspend admission of a specific category or categories of
patients as related to the violation by imposing a limited stop
placement.
(2) When the department orders a stop placement, the facility may
not admit any new patients until the stop placement order is
terminated. When the department orders a limited stop placement, the
facility may not admit any new patients in the category subject to
the limited stop placement until the limited stop placement order is
terminated.
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(a) Within fifteen business days of receiving written notice from
the licensee that describes how the violations necessitating the stop
placement or limited stop placement were corrected, the department
shall conduct a follow-up inspection to verify the corrections have
been made and implemented.
(b) The department shall terminate the stop placement or limited
stop placement when:
(i) The department verifies the violations necessitating the stop
placement or limited stop placement have been corrected; and
(ii) The facility establishes the ability to maintain correction
of the violations previously found deficient.
(c) This subsection does not prevent the department from
enforcing license suspensions or revocations. Nothing in this
subsection interferes with or diminishes the department's authority
and duty to enforce compliance with this section, chapter 71.12 RCW,
or the rules adopted under chapter 71.12 RCW or this section.
(3) RCW 43.70.115 governs notice of a license denial, revocation,
suspension, stop placement, limited stop placement, imposition of
conditions on a license, or modification, but the department may make
license suspension, stop placement, limited stop placement, or
conditions for continuation of a license effective immediately upon
receipt by the licensee or provisional licensee, pending any hearing.
(4) A license applicant or licensee who is aggrieved by
department action under this section may request an adjudicative
proceeding. The proceeding is governed by the administrative
procedure act, chapter 34.05 RCW. The application for an adjudicative
proceeding must be in writing, state the basis for contesting the
adverse action, include a copy of the adverse notice, be served on
and received by the department within twenty-eight days of the
license applicant's or licensee's receiving the adverse notice, and
be served in a manner that shows proof of receipt.

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NEW SECTION.
Sec. 3.
A new section is added to chapter 43.70
RCW to read as follows:
As resources allow, the department shall make health care
facility inspection and investigation reports available to the public
on the internet, starting with psychiatric hospitals.

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NEW SECTION.
Sec. 4.
RCW to read as follows:
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A new section is added to chapter 43.70
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The department must conduct a review of statutes for all health
care facility types regulated by the department to evaluate
appropriate levels of oversight and identify opportunities to
consolidate and standardize licensing and enforcement requirements
across facility types. The department must work with stakeholders to
create recommendations for a uniform health care facility enforcement
act for consideration in the 2021 legislative session.

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Sec. 5. RCW 71.12.455 and 2017 c 263 s 2 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) "Department" means the department of health.
(2) "Establishment" and "institution" mean:

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(a) Every private or county or municipal hospital, including
public hospital districts, sanitariums, homes, or other places
receiving or caring for any person with mental illness, mentally
incompetent person, or chemically dependent person; and
(b) Beginning January 1, 2019, facilities providing pediatric
transitional care services.
(3) "Pediatric transitional care services" means short-term,
temporary, health and comfort services for drug exposed infants
according to the requirements of this chapter and provided in an
establishment licensed by the department of health.
(4) "Secretary" means the secretary of the department of health.
(5) "Trained caregiver" means a noncredentialed, unlicensed
person trained by the establishment providing pediatric transitional
care services to provide hands-on care to drug exposed infants.
Caregivers may not provide medical care to infants and may only work
under the supervision of an appropriate health care professional.
(6) "Elopement" means any situation in which an admitted patient
of a psychiatric hospital who is cognitively, physically, mentally,
emotionally, and/or chemically impaired wanders, walks, runs away,
escapes, or otherwise leaves a psychiatric hospital prior to their
scheduled discharge unsupervised, unnoticed, and without the staff's
knowledge.
(7) "Psychiatric hospital" means a hospital caring for any person
with mental illness or substance use disorder excluding acute care
hospitals licensed under chapter 70.41 RCW, state psychiatric
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hospitals established under chapter 72.23 RCW, and residential
treatment facilities as defined in this section.
(8) "Residential treatment facility" means a facility in which
twenty-four hour on-site care is provided for the evaluation,
stabilization, or treatment of residents for substance use, mental
health, co-occurring disorders, or for drug exposed infants.
(9) "Technical assistance" means the provision of information on
the state laws and rules applicable to the regulation of psychiatric
hospitals, the process to apply for a license, and methods and
resources to avoid or address compliance problems. Technical
assistance does not include assistance provided under chapter 43.05
RCW.

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Sec. 6.
RCW 71.12.460 and 2001 c 254 s 2 are each amended to
read as follows:

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(1) No person, association, county, municipality, public hospital
district, or corporation, shall establish or keep, for compensation
or hire, an establishment as defined in this chapter without first
having obtained a license therefor from the department of health,
complied with rules adopted under this chapter, and paid the license
fee provided in this chapter. Any person who carries on, conducts, or
attempts to carry on or conduct an establishment as defined in this
chapter without first having obtained a license from the department
of health, as in this chapter provided, is guilty of a misdemeanor
and on conviction thereof shall be punished by imprisonment in a
county jail not exceeding six months, or by a fine not exceeding one
thousand dollars, or by both such fine and imprisonment. The managing
and executive officers of any corporation violating the provisions of
this chapter shall be liable under the provisions of this chapter in
the same manner and to the same effect as a private individual
violating the same.
(2) New psychiatric hospitals meeting the minimum licensing
requirements and any existing psychiatric hospital that changes
ownership after July 1, 2020, shall be issued a provisional license.
During the period of provisional licensing, the department must
provide
enhanced
oversight
through
inspections
and
technical
assistance. The provisional license is effective for a period of
twenty-four months and is not subject to renewal. The psychiatric
hospital is eligible to apply for a license sixty days before the end
of the provisional license period if the hospital has established
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that it is substantially compliant with this chapter and the rules
adopted under this chapter for at least three inspections. The
department shall verify the hospital's substantial compliance with
this chapter and the rules adopted under this chapter by conducting
at least three inspections of the hospital during the provisional
license period separated by at least one hundred twenty days.
(3) A provisional licensee that submits a license application
thirty to sixty days prior to expiration of the provisional license
in accordance with this section and the applicable rules and fee
schedule shall be deemed to possess a valid license for the year
following the expiration date of the provisional license, or until
the department denies the license application pursuant to this
section and chapter 71.12 RCW.
(4) The department shall issue a license to operate a psychiatric

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hospital after the psychiatric hospital has established that it has
substantially complied with the licensing requirements and rules
adopted under this chapter, and submits an application to the
department in such form and manner as the department requires. The
department may deny an application for a license to any applicant
that fails to meet the requirements in this section.

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Sec. 7.
RCW 71.12.470 and 2000 c 93 s 23 are each amended to
read as follows:
(1) Every application for a license or provisional license shall
be accompanied by a plan of the premises proposed to be occupied,
describing the capacities of the buildings for the uses intended, the
extent and location of grounds appurtenant thereto, and the number of
patients
proposed
to
be
received
therein,
with
such
other
information, and in such form, as the department of health requires.
The application shall be accompanied by the proper license fee. The
amount of the license and provisional license fees shall be
established by the department of health under RCW 43.70.110.
(2) Until the department of health establishes a separate
provisional license fee in rule, psychiatric hospitals seeking or
operating under a provisional license shall pay the annual
psychiatric hospital licensing fee.

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Sec. 8.
RCW 71.12.480 and 2000 c 93 s 24 are each amended to
read as follows:
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(1) The department of health shall not grant any such license
until it has made an examination of all phases of the operation of
the establishment necessary to determine compliance with rules
adopted under this chapter including the premises proposed to be
licensed and is satisfied that the premises are substantially as
described, and are otherwise fit and suitable for the purposes for
which they are designed to be used, and that such license should be
granted.
(2) The department shall perform at least three unannounced
inspections of a psychiatric hospital operating under a provisional
license during the provisional license period and conduct additional
inspections of the hospital as necessary to determine whether the
hospital has met the requirements in RCW 71.12.460 for licensure.

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NEW SECTION.
Sec. 9.
A new section is added to chapter 71.12
RCW to read as follows:
Every psychiatric hospital licensed or provisionally licensed
under this chapter shall report to the department every patient
elopement and every death that occurs on the hospital grounds within
three days of the elopement or death to the department's complaint
intake system or another reporting mechanism specified by the
department in rule.

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NEW SECTION. Sec. 10. A new section is added to chapter 71.12
RCW to read as follows:
Upon request, the department shall make available technical
assistance to psychiatric hospitals in compliance with all categories
of regulation, except during the time between when an investigation
of a psychiatric hospital has been initiated and when such
investigation is resolved.

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Sec. 11.
RCW 71.12.500 and 2000 c 93 s 25 are each amended to
read as follows:
The department of health may at any time examine and ascertain
how far a licensed establishment is conducted in compliance with this
chapter, the rules adopted under this chapter, and the requirements
of the license therefor. If the interests of the patients of the
establishment so demand, the department may, for just and reasonable
cause, suspend, modify, or revoke any such license or provisional
license. RCW 43.70.115 governs notice of a license denial,
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revocation, suspension, or modification and provides the right to an
adjudicative proceeding.

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NEW SECTION. Sec. 12. This act is necessary for the immediate
preservation of the public peace, health, or safety, or support of
the state government and its existing public institutions, and takes
effect immediately.
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