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– WASHINGTON –
Public and Private Policy
Medical Errors and Patient Safety

Initiatives and Legislative Activity

Included in the tables below are public inititiatives and legislative activities for the 105-day 2005 session and 60-day 2006 session of the 59th Legislature of Washington. The list below includes only those bills and initiatives addressing 1) patient safety, 2) medical errors, 3) continuous quality improvement programs – CQIP, (which includes peer review and quality improvement), 4) medical liability, or 5) public disclosure / transparency.*


* It is oftentimes nearly impossible to address one without addressing another, and these classifications are intended to suggest perceived predominant intents or effects. See Statutes / Rules for existing Washington laws on these topics.


Medical Liability Reform has received primary focus of both the legislative and the initiative processes of 2005-2006. Many of the bills that failed to pass were introduced as alternatives to Initiative 330 [PDF] and Initiative 336 [PDF], which failed in November 2005.

A comprehensive major bill that passed in 2006, HB 2292 includes compromises for many of the hotly contested features of Initiatives 330 and 331 and other legislation that failed to pass in the 2005 session. The legislation also included requirements for revisions in the existing reporting of adverse events and near-misses by hospitals.

Failing to pass in 2006 despite considerable attention were companion house (HB 1291) and senate (SB 5318) bills that which would have created a ‘Patient Safety Account’ to fund projects designed to reduce medical errors or promote patient safety.

Summary of Initiatives and Bills By Sub-category

59th Washington Legislature, 2005 – 2006
Bills & Passage-year
Patient
Safety
Medical
Error
CQIP
Activity
Medical
Liability
Disclosure/
Transparency
House Senate Y/N
HB 1512 SB 5390 Yes-05 X X
HB 1569 SB 5698 Yes-05 X
HB 1672 - - - Yes-06 X X
EHB 2254 - - - Yes-05 X X
HB 2573 SB 6307 Yes-06 X
- - - SB 5064 Yes-05 X
- - - SB 5065 Yes-05 X X X
HB 1148 SB 5146 Yes-05 X
HB 2292 SB 6087 Yes-06 X X X X X
HB 2575 SB 6306 Yes-06 X
Init 330 No-05 X X X
Init 336 No-05 X X X X X
HB 1015 - - - No X X X
SHB 1243 - - - No X X X X
HB 1291 SB 5318 No X X X X
HB 1372 - - - No X X
HB 1548 SB 5764 No X
HB 1710 - - - No X
HB 1777 - - - No X X
HB 1780 - - - No X X
HB 1858 - - - No X
HB 1859 - - - No X
HB 1861 - - - No X
HB 1862 - - - No X
HB 1946 - - - No X
HB 2279 SB 6072 No X X
HB 2295 - - - No X X X X X
HB 2969 - - - No X X
- - - SB 6063 No X X

Initiatives and Bills that Passed

Year Topic Bill No. Status Description
2005-06 Extends confidentiality to all Quality Improvement Committees and Board of Commissioners HB 1148, companion bill with SB 5146 Passed CH 169, (2005) [PDF] The bill allows confidential quality improvement committee meetings, proceedings, and deliberations in public hospital districts, which are municipal corporations that own and/or operate hospitals and other health care facilities. grants discretion for confidentiality to QI Committees and Board of Commissioners in reviewing all reports or activities of a quality improvement committee.
2005 An act relating to incentives to improve quality of care in state purchased health care programs utilizing Evidence-Based Medicine HB 1512 companion bill to SB 5390 Passed CH 446, (2005) [PDF] The bill requires the use of evidence-based medicine principles in state-purchased health care and encourages financial incentives to reward improvements in health outcomes for individuals with chronic disease, increased use of preventive services, and reductions in medical errors. The bill also directs the adoption and use of information technology to achieve these goals.
2005 An act relating to quality assurance in boarding homes, nursing homes, hospitals, peer review organizations, and coordinated quality improvement plans HB 1569, companion bill SB 5698 Passed CH 33, (2005) [PDF] The bill authorizes nursing homes to maintain a quality assurance committee. Similar to protections afforded to hospitals, the bill establishes that information and documents developed for a quality assurance committee are not subject to discovery in legal proceedings.
2005-06 Requires hospitals to establish lift teams and provide mechanical lifting devices or equipment to move patients. HB 1672 Passed as CH 165, (2006) [PDF] Hospitals required to have policies in place to assure patient safety of patients and healthcare workers. Establishment of lift teams or the provision of mechanical lifting devices or equipment to conduct patient lifts, transfers, and repositioning would be required. The goal is to reduce injuries among patients and health care workers, who lead the nation in work-related musculoskeletal disorders, thereby increasing workman's compensation attributable to manual lifting.
2005 Clarifying protections provided to quality improvement activities EHB 2254 Passed CH 291, (2005) [PDF] The bill assures that review or disclosure of information and documents specifically created for, and collected and maintained by, quality improvement and peer review committees is prohibited unless there is a specific exception. Because of an unintended threat to the peer review process if Initiative 336 were to pass, this bill was passed to maintain the peer review protections. The law prior to passage of this bill protected peer review from discovery in the course of a civil action, but did not provide general protection from disclosure. HB2254 makes it clear that peer review and QI information is protected regardless of whether the request arises in the context of litigation or otherwise. A discussion is provided in the WSHA 2005 Legislative Summary [PDF, p.16].
2006 Requires HCA and Correctional Institutions to include Health Information Technology strategies in purchasing and reimbursement contracts to minimize service duplication, promote CPOE, and improve patient outcomes HB 2573, companion bill to SB 6307 Passed CH 103, (2006) [PDF] HCA contracts for healthcare must promote and increase the adoption of health information technology systems by all providers via reimbursement and state health purchasing strategies as well as pilot studies. HIT systems must facilitate diagnosis or treatment; reduce unnecessary duplication of tests; promote efficient electronic physician order entry; increase access to health information for consumers and their providers; and improve health outcomes. A target date of 2012 should be imposed upon providers in keeping with this strategy. The Department of Corrections must create a demonstration project to establish an integrated electronic health records system to facilitate and expedite the transfer of inmate health information between state and local correctional facilities with recommendations to the legislature by December 2006.
2005 Studying the use of electronic medical records SSB 5064 Passed with gubernatorial veto of Section 3, CH 261, (2005) [PDF] This bill creates the Washington Health Information Advisory Board (WHIAB) to be composed of 7 to 12 members, appointed by the WA Health Care Authority (HCA). The bill encourages the use of health information technology to support high quality, cost-effective health care. The governor vetoed section 3, which would have required the WA HCA to provide staff support to the advisory board and would have directed all agencies under the control of the governor, plus other agencies as requested, to render full assistance and cooperation to the advisory board.
2005 Requiring notice of potential injuries resulting from health care. SSB 5065 Passed CH 118, (2005) [PDF] Hospitals required to have policies in place to assure that information about unanticipated outcomes is provided to patients, families, or surrogate decision makers. Notifications of unanticipated outcomes do not constitute an acknowledgement or admission of liability, nor can notification, statements, apologies, etc. be introduced as evidence in a civil action. Enforcement begins with licensure evaluations in 2006.
2005 Extends Confidentiality of CQIPs to Public Hospital districts SB 5146, companion bill with HB 1148 Passed CH 169, (2005) [PDF] The law allows confidential quality improvement committee meetings, proceedings, and deliberations in public hospital districts, which are municipal corporations that own and/or operate hospitals and other health care facilities.
2005-06 Complex bill addressing medical liability and offering alternatives to Initiatives 330 and 336 that failed in 2005 election. SHB 2292

2ESHB 2292, companion bill to SB 6087
Passed with extensive amendments in CH 8, (2006)

Bill introduced as alternatives to Initiative 330 and Initiative 336 that addressed medical malpractice claims without imposing mandatory limits on damage awards or fees. In addition the bill provided the insurance commissioner with the authority to regulate medical malpractice insurance rates.

The bill morphed into a comprehensive bill, features of which included:

  • •  Statements of Apology for medical error not discoverable,
  • •  Whistle-blower immunity to reporter of adverse events reflecting unprofessional conduct of professional licensee (both professional licensee reporters and others),
  • •  2 additional 'public' members outside the healthcare industry added to Medical Quality Assurance Commission,
  • •  mandatory close-claim reporting by Insurance industry,
  • •  rules for voluntary and mandatory mediation features,
  • •  change of medical error reporting to Internet reporting using NQF definitions for adverse events standard, and requiring incident (near miss) reporting to independent Patient Safety Organization,
  • •  Prescriptions must be hand printed, typewritten, or electronically generated
  • •  Other misc. liability and Insurance reforms
2005-06 An act establishing an Evidence-Based Health Technology Assessment Program that creates a statewide health technology clinical committee, promotes the use of systematic reviews of scientific and medical literature, and funds evidence-based health technology assessments HB 2575

E2SHB 2575, companion bill to SB 6306
Passed as CH 307, (2006) [PDF]

The bill establilshes a program within the WA Health Care Authority to provide for evidence-based approval of new and existing medical technologies as they are incorporated into medicine. A 11 member health technology clinical committee composed of 6 physicians and 5 other healthcare professionals is created to assess technologies and their approval for remuneration, based upon evidence-based assessments that might be provided by one of 13 Evidence-based Practice Centers (EPCs) approved by AHRQ in 2002. Fiscal appropriations include 3.3 FTEs for the Health Care Authority plus moneys from the General Fund totalling $3,046,000 per biennium through 2011.

2005 An act relating to quality assurance in boarding homes, nursing homes, hospitals, peer review organizations, and coordinated quality improvement plans SB 5698, companion bill to HB 1569 Passed CH 33, (2005) [PDF] The bill authorizes nursing homes to maintain a quality assurance committee. Similar to protections afforded to hospitals, the bill establishes that information and documents developed for a quality assurance committee are not subject to discovery in legal proceedings.
2005-06 Complex bill addressing medical liability and offering alternatives to Initiatives 330 and 336 that failed in 2005 election. SB 6087, companion bill to SHB 2292

2ESHB 2292
Passed with extensive amendments in CH 8, (2006) [PDF]

Bill introduced as alternatives to Initiative 330 and Initiative 336 that addressed medical malpractice claims without imposing mandatory limits on damage awards or fees. In addition the bill provided the insurance commissioner with the authority to regulate medical malpractice insurance rates.

The bill morphed into a comprehensive bill, features of which included:

  • •  Statements of Apology for medical error not discoverable,
  • •  Whistle-blower immunity to reporter of unprofessional conduct of professional licensee (both professional licensee reporters and others),
  • •  4 'public' members added to 19-member MQAC committee,
  • •  mandatory close-claim reporting by Insurance industry,
  • •  mandatory mediation features,
  • •  change of medical error reporting to Internet reporting using NQF definitions for adverse events standard, and requiring incident (near miss) reporting to independent Patient Safety Organization,
  • •  Prescriptions must be hand printed, typewritten, or electronically generated
  • •  Other misc. liability and Insurance reforms
2005-06 An act establishing an Evidence-Based Health Technology Assessment Program that creates a statewide health technology clinical committee, promotes the use of systematic reviews of scientific and medical literature, and funds evidence-based health technology assessments SB 6306, companion bill to HB 2575

E2SHB 2575
Passed as CH 307, (2006) [PDF]

The bill establilshes a program within the WA Health Care Authority to provide for evidence-based approval of new and existing medical technologies as they are incorporated into medicine. A 11 member health technology clinical committee composed of 6 physicians and 5 other healthcare professionals is created to assess technologies and their approval for remuneration, based upon evidence-based assessments that might be provided by one of 13 Evidence-based Practice Centers (EPCs) approved by AHRQ in 2002. Fiscal appropriations include 3.3 FTEs for the Health Care Authority plus moneys from the General Fund totalling $3,046,000 per biennium through 2011.

2006 Requires HCA and Correctional Institutions to include Health Information Technology strategies in purchasing and reimbursement contracts to minimize service duplication, promote CPOE, and improve patient outcomes SB 6307, companion bill to HB 2573 Passed CH 103, (2006) [PDF] HCA contracts for healthcare must promote and increase the adoption of health information technology systems by all providers via reimbursement and state health purchasing strategies as well as pilot studies. HIT systems must facilitate diagnosis or treatment; reduce unnecessary duplication of tests; promote efficient electronic physician order entry; increase access to health information for consumers and their providers; and improve health outcomes. A target date of 2012 should be imposed upon providers in keeping with this strategy. The Department of Corrections must create a demonstration project to establish an integrated electronic health records system to facilitate and expedite the transfer of inmate health information between state and local correctional facilities with recommendations to the legislature by December 2006.

Initiatives and Bills that Died/Failed to Pass

All bills that failed to pass in the 105-day long 2005 session may be re-introduced in the 60-day long 2006 session of the 2-year 59th Washington Legislature. As such, some of these bills that are familiar to most legislatures may again be revived as "carryover" bills that may have greater chances of passage, especially if they have survived committee scrutiny and/or passed 2nd reading or 3rd reading with referral to the other legislative house.

Year Topic Bill No. Status Description
2005 House Bills that Failed to Pass
2005-06 Requiring reporting and public disclosure of Healthcare Acquired Infections (HAI) including individual facility-identified rates HB 1015

E2SHB 1015
Did Not Pass Requires each hospital to: (1) Collect information regarding hospital-acquired infection rates for the specific clinical procedures and categories, (2) preparation of quarterly reports to the DOH, and (3) publication of annual report of hospital-identified HAI rates. 2006 Bill passed from House but died in Senate, failing to achieve resolution on the issue of accountability. . . i.e., where individual hospital HAI rates should be publicly available.
2005-06 Increasing patient safety through disclosure and analysis of adverse events SHB 1243 Did Not Pass Bill would have required:
  • √  Extending adverse event reporting to the DOH to include ambulatory surgical facilities, childbirth centers, correctional medical facilities, hospitals, and psychiatric hospitals
  • √  Annual report from the DOH to the governor, the legislature, and the public (via the DOH website)
  • √  Reporting of events by medical facilities on a geographical basis
  • √  Medical facilities must provide written notification to patients that may have been affected by the adverse event [A similar provision became law as part of SSB 5065]
  • √  Provides that evidence of statements of apology or remedial acts by a health care provider is inadmissible in an action for professional negligence [A similar provision became law as part of SSB 5065].
  • √   Despite not passing in 2005 session, all features of the original bill were either passed in 2005 legislation noted above or included as part of broadened adverse event reporting program that passed in 2006 (HB 2292).
2005-06 Creation of "Patient Safety Account," and inadmissibility of apologies in actions of professional negligence, and establishment of standards for prescriptions. 1291

2E2SHB HB 1291 Companion bill to SB5318
Did Not Pass Bill, as finally amended, creates the Patient Safety Account to fund patient safety and medical error reduction programs through funds raised by (1) a charge to health care providers ($2/license) and acute care and psychiatric hospitals ($2/licensed bed), and (2) payment of 1 percent of attorneys' fees in actions for injuries resulting from health care. Account for use in projects designed to reduce medical errors or promote patient safety.
2005-06 Requires hospitals to establish hospital staffing plans for nursing services and establishing recordkeeping and reporting requirements HB 1372 Did Not Pass Hospitals would have been required to develop and implement staffing plans for nursing services to ensure that the classifications, skills, experiences, and numbers of health care professionals providing direct patient care are sufficient to meet the needs of patients.
2005-06 Provides immunity from a civil action to a health care provider who reports another provider's unprofessional conduct or lack of capacity to practice safely HB 1548, companion bill to SB 5764 Did Not Pass Bill provides that immunity is granted to physicians, dentists, and pharmacists who in good faith file charges or present evidence to a disciplining authority about incompetence or misconduct of another physician, dentist, or pharmacist. A health care professional who prevails in a civil action on the good faith defense provided in this immunity statute is entitled to recover expenses and reasonable attorneys' fees incurred in establishing the defense. This initiative did not pass in 2005, but all features of this bill were incorporated into HB 2292 that passed in 2006.
2005-06 Providing for health care staffing level reporting HB 1710 Did Not Pass The bill would have required hospitals and nursing homes to post nurse-to-patient ratio for each unit for each shift, including the RNs, LPNs, CNAs, and unlicensed personnel. Hospitals would have been required to compile and report data to the DOH every 6-months.
2005-06 Establishment of Joint Task Force to Evaluate alternatives to addressing disputes and litigation surrounding patient injury HB 1777 Did Not Pass Bill called for establishment of a joint task force for an impartial examination of issues surrounding resolution of disputes related to injuries occurring as a result of health care, with the goal of developing recommendations for prompt resolution of these disputes that provides equitable results for all of the individuals and entities involved.
2005-06 Regarding legibility of prescriptions HB 1780 Did Not Pass Requires a prescription to be hand printed, typewritten, or electronically generated to improve legibility of prescriptions and patient safety. This initiative did not pass in 2005, but it was incorporated verbatim into HB 2292 that passed in 2006.
2005-06 Limiting the time period for bringing an action for personal injury or death resulting from health care. HB 1858 Did Not Pass Limits claims to those occurring within 3 years of a patient injury or within 1 year of learning of injury. For minors who sustain injury, they must make claims within 3 years of age 18 or 1 year of learning of injury. A person may not bring a medical malpractice action more than eight years after the alleged act or omission except in the case of an injury to a minor where the parent knew of the claim and failed to bring the action on behalf of the minor. This bill would have extended the time a minor has to make claim for a birth-related injury and/or medical error. This initiative did not pass in 2005, but some features of this bill were incorporated into HB 2292 that passed in 2006.
2005-06 Creating the Washington birth-related injury compensation association HB 1859 Did Not Pass Under the guise of stabilizing medical malpractice premiums for obstetric healthcare providers, this bill provided compensation on a no-fault basis for birth-related injuries that require high-cost custodial care or intensive rehabilitiation. Cost were to be borne by hospitals @ $50 per birth. No protections against civil liability afforded by this plan.
2005-06 Medical Malpractice bill encouraging earlier resolution of health care claims HB 1861 Did Not Pass Requires 90 days notice to a defendant before a medical malpractice action may be commenced. Provides that all medical malpractice claims are subject to mandatory mediation unless the claim is submitted to arbitration or another dispute resolution process. Establishes provisions for offers of settlement in medical malpractice actions, with the potential for prevailing party attorneys’ fees.
2005-06 Changing provisions relating to parties' liabity for damages in actions under chapter 7.70 RCW. HB 1862 Did Not Pass The bill would have reformed joint and several liability, but for non-economic damages only.
2005-06 Establishing prerequisites for filing an action for injury occurring as a result of health care HB 1946 Did Not Pass Bill requires that before proceding to litigation, each claimant must provide at least ninety days’ written notice of intent to file a claim, including a request to meet and discuss the claim.
2005-06 Providing for omnibus civil liability reform HB 2279, companion bill to SB 6072 Did Not Pass Directs the department of health to develop, in consultation with the department of revenue, a program to provide business and occupation tax credits for physicians who serve uninsured, medicare, and medicaid patients in a private practice or a reduced fee access program for the uninsured. Non-economic damages are capped at $1M.
2005-06 Changes to healthcare liability laws HB 2295 Did Not Pass Declares an intent to promote full disclosure of medical errors and adverse health events, and to use the experience and knowledge gained from analysis of those events to advance patient safety in a nonpunitive manner. Advocates for full disclosure of medical errors. Advocates alternatives to Initiatives 330 and 336. Assesses fees on hospitals, physicians, and medical malpractice attorneys to pay for projects that rely primarily upon evidence-based practices to improve patient safety and that have been identified and recommended by governmental and private organizations.
2006 Create legislative oversight committee to assess patient access, treatment quality, and healthcare costs. HB 2969 Did Not Pass The bill suggests that the state should use available, valid evidence to improve access to needed medicines and other health care items and services and improve the quality of care received by individuals in state purchased health care programs. The bill calls for creation of a legislative oversight committee to review and report at least yearly on the impact of evidence reports on patient access, treatment quality, and overall health care costs.
2005 Senate Bills Failing to Pass
2005-06 Establishes "Patient Safety Account" and declares and inadmissibility of apologies in actions of professional negligence SB 5318

SSB 5318, companion Bill to HB 1291
Did Not Pass Except for features addressing prescriptions, the bill includes similar features to HB 1291.
2005-06 Provides immunity from a civil action to a health care provider who reports another provider's unprofessional conduct or lack of capacity to practice safely SB 5764, companion bill to HB 1548 Did Not Pass Bill provides that immunity is granted to physicians, dentists, and pharmacists who in good faith file charges or present evidence to a disciplining authority about incompetence or misconduct of another physician, dentist, or pharmacist. A health care professional who prevails in a civil action on the good faith defense provided in this immunity statute is entitled to recover expenses and reasonable attorneys' fees incurred in establishing the defense. This initiative did not pass in 2005, but all features of this bill were incorporated into HB 2292 that passed in 2006.
2005-06 Medical Malpractice reform limiting damages against health care providers SB 6063 Did Not Pass The bill addresses the reasonableness of attorneys's fees and capped non-economic damages at $1,000,000.
2005-06 Civil liability reform affecting healthcare providers and medical malpractice assistance SB 6072, companion bill to HB 2279 Did Not Pass Directed the DOH to provide business and occupation tax credits for physicians who serve uninsured, medicare, and medicaid patients in a private practice or a reduced fee access program for the uninsured, and provided civil liberties reform.
2005 Initiatives Failing to Pass
2005 Limiting Recovery for Medical Malpractice Claims and Imposing other Restrictions Initiative 330 [PDF] Did Not Pass This measure would change laws governing claims for negligent healthcare, including restricting noneconomic damages to $350,000 (with exception), shortening time limits for filing cases, limiting repayments to insurers, and limiting claimants’ attorney fees. [see League of Women’ Voters Analysis – [PDF]]
2005 Medical Malpractice Reform, Health Care Provider Licensing and Consumer Rights Initiative 336 [PDF] Did Not Pass This measure would: require notices and hearings on insurance rate increases; establish a supplemental malpractice insurance program; require license revocation proceedings after three malpractice incidents; and limit the numbers of expert witnesses in lawsuits. [see League of Women’ Voters Analysis – [PDF]]
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