Revised Code of Washington
Chapter 43.70 - Department of Health.
43.70.510 - Health care services coordinated quality improvement program—Rules.

RCW 43.70.510
Health care services coordinated quality improvement program—Rules.

(1)(a) Health care institutions and medical facilities, other than hospitals, that are licensed by the department, professional societies or organizations, health care service contractors, health maintenance organizations, health carriers approved pursuant to chapter 48.43 RCW, and any other person or entity providing health care coverage under chapter 48.42 RCW that is subject to the jurisdiction and regulation of any state agency or any subdivision thereof may maintain a coordinated quality improvement program for the improvement of the quality of health care services rendered to patients and the identification and prevention of medical malpractice as set forth in RCW 70.41.200.
(b) All such programs shall comply with the requirements of RCW 70.41.200(1) (a), (c), (d), (e), (f), (g), and (h) as modified to reflect the structural organization of the institution, facility, professional societies or organizations, health care service contractors, health maintenance organizations, health carriers, or any other person or entity providing health care coverage under chapter 48.42 RCW that is subject to the jurisdiction and regulation of any state agency or any subdivision thereof, unless an alternative quality improvement program substantially equivalent to RCW 70.41.200(1)(a) is developed. All such programs, whether complying with the requirement set forth in RCW 70.41.200(1)(a) or in the form of an alternative program, must be approved by the department before the discovery limitations provided in subsections (3) and (4) of this section and the exemption under RCW 42.56.360(1)(c) and subsection (5) of this section shall apply. In reviewing plans submitted by licensed entities that are associated with physicians' offices, the department shall ensure that the exemption under RCW 42.56.360(1)(c) and the discovery limitations of this section are applied only to information and documents related specifically to quality improvement activities undertaken by the licensed entity.
(2) Health care provider groups of five or more providers may maintain a coordinated quality improvement program for the improvement of the quality of health care services rendered to patients and the identification and prevention of medical malpractice as set forth in RCW 70.41.200. For purposes of this section, a health care provider group may be a consortium of providers consisting of five or more providers in total. All such programs shall comply with the requirements of RCW 70.41.200(1) (a), (c), (d), (e), (f), (g), and (h) as modified to reflect the structural organization of the health care provider group. All such programs must be approved by the department before the discovery limitations provided in subsections (3) and (4) of this section and the exemption under RCW 42.56.360(1)(c) and subsection (5) of this section shall apply.
(3) Any person who, in substantial good faith, provides information to further the purposes of the quality improvement and medical malpractice prevention program or who, in substantial good faith, participates on the quality improvement committee shall not be subject to an action for civil damages or other relief as a result of such activity. Any person or entity participating in a coordinated quality improvement program that, in substantial good faith, shares information or documents with one or more other programs, committees, or boards under subsection (6) of this section is not subject to an action for civil damages or other relief as a result of the activity or its consequences. For the purposes of this section, sharing information is presumed to be in substantial good faith. However, the presumption may be rebutted upon a showing of clear, cogent, and convincing evidence that the information shared was knowingly false or deliberately misleading.
(4) Information and documents, including complaints and incident reports, created specifically for, and collected and maintained by, a quality improvement committee are not subject to review or disclosure, except as provided in this section, or discovery or introduction into evidence in any civil action, and no person who was in attendance at a meeting of such committee or who participated in the creation, collection, or maintenance of information or documents specifically for the committee shall be permitted or required to testify in any civil action as to the content of such proceedings or the documents and information prepared specifically for the committee. This subsection does not preclude: (a) In any civil action, the discovery of the identity of persons involved in the medical care that is the basis of the civil action whose involvement was independent of any quality improvement activity; (b) in any civil action, the testimony of any person concerning the facts that form the basis for the institution of such proceedings of which the person had personal knowledge acquired independently of such proceedings; (c) in any civil action by a health care provider regarding the restriction or revocation of that individual's clinical or staff privileges, introduction into evidence information collected and maintained by quality improvement committees regarding such health care provider; (d) in any civil action challenging the termination of a contract by a state agency with any entity maintaining a coordinated quality improvement program under this section if the termination was on the basis of quality of care concerns, introduction into evidence of information created, collected, or maintained by the quality improvement committees of the subject entity, which may be under terms of a protective order as specified by the court; (e) in any civil action, disclosure of the fact that staff privileges were terminated or restricted, including the specific restrictions imposed, if any and the reasons for the restrictions; or (f) in any civil action, discovery and introduction into evidence of the patient's medical records required by rule of the department of health to be made regarding the care and treatment received.
(5) Information and documents created specifically for, and collected and maintained by, a quality improvement committee are exempt from disclosure under chapter 42.56 RCW.
(6) A coordinated quality improvement program may share information and documents, including complaints and incident reports, created specifically for, and collected and maintained by, a quality improvement committee or a peer review committee under RCW 4.24.250 with one or more other coordinated quality improvement programs maintained in accordance with this section or with RCW 70.41.200, a coordinated quality improvement committee maintained by an ambulatory surgical facility under RCW 70.230.070, a quality assurance committee maintained in accordance with RCW 18.20.390 or 74.42.640, or a peer review committee under RCW 4.24.250, for the improvement of the quality of health care services rendered to patients and the identification and prevention of medical malpractice. The privacy protections of chapter 70.02 RCW and the federal health insurance portability and accountability act of 1996 and its implementing regulations apply to the sharing of individually identifiable patient information held by a coordinated quality improvement program. Any rules necessary to implement this section shall meet the requirements of applicable federal and state privacy laws. Information and documents disclosed by one coordinated quality improvement program to another coordinated quality improvement program or a peer review committee under RCW 4.24.250 and any information and documents created or maintained as a result of the sharing of information and documents shall not be subject to the discovery process and confidentiality shall be respected as required by subsection (4) of this section and RCW 4.24.250.
(7) The department of health shall adopt rules as are necessary to implement this section.

[ 2007 c 273 § 21. Prior: 2006 c 8 § 113; 2005 c 291 § 2; 2005 c 274 § 302; 2005 c 33 § 6; 2004 c 145 § 2; 1995 c 267 § 7; 1993 c 492 § 417.]
NOTES:

Effective date—Implementation—2007 c 273: See RCW 70.230.900 and 70.230.901.


Findings—Intent—Part headings and subheadings not law—Severability—2006 c 8: See notes following RCW 5.64.010.


Findings—2005 c 33: See note following RCW 18.20.390.


Captions not law—Severability—Effective dates—1995 c 267: See notes following RCW 43.70.052.


Findings—Intent—1993 c 492: See notes following RCW 43.20.050.


Short title—Savings—Reservation of legislative power—Effective dates—1993 c 492: See RCW 43.72.910 through 43.72.915.

Structure Revised Code of Washington

Revised Code of Washington

Title 43 - State Government—Executive

Chapter 43.70 - Department of Health.

43.70.005 - Intent.

43.70.010 - Definitions.

43.70.020 - Department created.

43.70.030 - Secretary of health.

43.70.040 - Secretary's powers—Rule-making authority—Report to the legislature.

43.70.041 - Five-year formal review process of existing rules.

43.70.045 - Warren Featherstone Reid Award for Excellence in Health Care.

43.70.047 - Warren Featherstone Reid Award for Excellence in Health Care.

43.70.050 - Collection, use, and accessibility of health-related data.

43.70.052 - Hospital financial and patient discharge data—Financial reports—Data retrieval—American Indian health data—Reporting—Patient discharge data—Confidentiality and protection.

43.70.053 - Hospital consolidated annual income—Reporting.

43.70.054 - Health care data standards—Submittal of standards to legislature.

43.70.056 - Health care-associated infections—Data collection and reporting—Advisory committee—Rules.

43.70.057 - Hospital emergency room patient care information—Data collection, maintenance, analysis, and dissemination—Rules.

43.70.060 - Duties of department—Promotion of health care cost-effectiveness.

43.70.064 - Health care quality—Findings and intent—Requirements for conducting study under RCW 43.70.066.

43.70.066 - Study—Uniform quality assurance and improvement program—Reports to legislature—Limitation on rule making.

43.70.068 - Quality assurance—Interagency cooperation.

43.70.070 - Duties of department—Analysis of health services.

43.70.075 - Identity of whistleblower protected—Remedy for retaliatory action—Definitions—Rules.

43.70.080 - Transfer of powers and duties from the department of social and health services.

43.70.081 - Transfer of certain behavioral health-related powers, duties, and functions from the department of social and health services.

43.70.090 - Authority to administer oaths and issue subpoenas—Provisions governing subpoenas.

43.70.095 - Civil fines.

43.70.097 - Enforcement in accordance with RCW 43.05.100 and 43.05.110.

43.70.100 - Reports of violations by secretary—Duty to institute proceedings—Notice to alleged violator.

43.70.110 - License fees—Costs—Other charges—Waiver.

43.70.112 - Online access to health care resources—Annual accounting of use of funds and use of online resources—University of Washington.

43.70.115 - Licenses—Denial, suspension, revocation, modification.

43.70.117 - Health care professionals licensed in another state or United States territory or the District of Columbia—In-state practice on a limited basis—Requirements—Limitations.

43.70.120 - Federal programs—Rules—Statutes to be construed to meet federal law.

43.70.125 - Health care facility certification—Unfunded federal mandates—Applicant fees.

43.70.130 - Powers and duties of secretary—General.

43.70.140 - Annual conference of health officers.

43.70.150 - Registration of vital statistics.

43.70.170 - Threat to public health—Investigation, examination or sampling of articles or conditions constituting—Access—Subpoena power.

43.70.180 - Threat to public health—Order prohibiting sale or disposition of food or other items pending investigation.

43.70.185 - Inspection of property where marine species located—Prohibitions on harvest or landing—Penalties.

43.70.190 - Violations—Injunctions and legal proceedings authorized.

43.70.195 - Public water systems—Receivership actions brought by secretary—Plan for disposition.

43.70.200 - Enforcement of health laws and state or local rules and regulations upon request of local health officer.

43.70.210 - Right of person to rely on prayer to alleviate ailments not abridged.

43.70.220 - Transfer of powers and duties from the department of licensing.

43.70.230 - Office of health consumer assistance created—Duties.

43.70.240 - Written operating agreements.

43.70.250 - License fees for professions, occupations, and businesses.

43.70.260 - Appointment of temporary additional members of boards and committees for administration and grading of examinations.

43.70.270 - License moratorium for persons in the service—Rules.

43.70.280 - Procedure for issuance, renewal, or reissuance of credentials—Extension or modification of licensing, certification, or registration period authorized.

43.70.290 - Funeral directors and embalmers subject to chapter 18.130 RCW.

43.70.300 - Secretary or secretary's designee ex officio member of health professional licensure and disciplinary boards.

43.70.310 - Cooperation with department of ecology.

43.70.320 - Health professions account—Fees credited—Requirements for biennial budget request—Unappropriated funds.

43.70.323 - Hospital infection control grant account.

43.70.327 - Public health supplemental account—Annual statement.

43.70.334 - Temporary worker housing—Definition.

43.70.335 - Temporary worker housing operating license—Fee—Display—Suspension or revocation—Fines—Refunds—Rules—Application of department of labor and industries standards.

43.70.337 - Temporary worker housing building permit—Plans and specifications—Fees—Rules.

43.70.340 - Temporary worker housing inspection fund—Fees on temporary worker housing operating licenses and building permits—Licenses generally.

43.70.400 - Head injury prevention—Legislative finding.

43.70.410 - Head injury prevention—Program, generally.

43.70.420 - Head injury prevention—Information preparation.

43.70.430 - Head injury prevention—Guidelines on training and education—Training of emergency medical personnel.

43.70.435 - Diagnosed concussions of students—Report.

43.70.440 - Head injury prevention act—Short title—1990 c 270.

43.70.442 - Suicide assessment, treatment, and management training—Requirement for certain professionals—Exemptions—Model list of programs—Rules—Health profession training standards provided to the professional educator standards board.

43.70.443 - Study of evidence-based suicide assessment, treatment, and management training—Report—Updates.

43.70.444 - Washington plan for suicide prevention—Steering committee—Report.

43.70.446 - Suicide-safer homes project—Suicide-safer homes project account.

43.70.447 - Suicide assessment, treatment, and management—Curriculum for dental students and dentists.

43.70.452 - Agricultural industry workforce behavioral health improvement and suicide prevention—Pilot program.

43.70.460 - Retired primary and specialty care provider liability malpractice insurance—Program authorized.

43.70.470 - Retired health care provider liability malpractice insurance—Conditions.

43.70.480 - Emergency medical personnel—Futile treatment and natural death directives—Guidelines.

43.70.490 - Emergency medical service personnel training program—Assistance to persons with disabilities—Requirements—Law enforcement officer training—Definitions.

43.70.495 - Telemedicine training for health care professionals.

43.70.500 - Health care services practice indicators and risk management protocols.

43.70.510 - Health care services coordinated quality improvement program—Rules.

43.70.512 - Public health system—Foundational public health services—Intent.

43.70.515 - Foundational public health services—Funding.

43.70.525 - Immunization assessment and enhancement proposals by local jurisdictions.

43.70.526 - Childhood immunizations—Resources for expecting parents.

43.70.533 - Chronic conditions—Training and technical assistance for primary care providers.

43.70.540 - Data collection—Legislative finding and intent.

43.70.545 - Data collection and reporting rules.

43.70.550 - Public health services improvement plan—Contents.

43.70.555 - Assessment standards.

43.70.560 - Media violence—Reporting reduction efforts.

43.70.570 - Intent—1995 c 43.

43.70.575 - Definitions.

43.70.590 - American Indian health care delivery plan.

43.70.595 - Health equity zones.

43.70.600 - Survey regarding exposure to radio frequencies—Results.

43.70.605 - Personal wireless services—Random testing on power density analysis—Rules.

43.70.610 - Domestic violence education program—Established—Findings.

43.70.613 - Health care professionals—Health equity continuing education.

43.70.615 - Multicultural health awareness and education program—Integration into health professions basic education preparation curriculum.

43.70.617 - Prenatal nutrition best practices—Educational resources for pregnant women.

43.70.619 - Pregnancy complications—Informational resources.

43.70.620 - List of contacts—Health care professions.

43.70.630 - Cost-reimbursement agreements.

43.70.640 - Workplace breastfeeding policies—Infant-friendly designation.

43.70.645 - Donor human milk—Milk bank safety standards.

43.70.650 - School sealant endorsement program—Rules—Fee—Report to the legislature.

43.70.660 - Product safety education.

43.70.665 - Early detection breast and cervical cancer screening program—Medical advisory committee.

43.70.670 - Human immunodeficiency virus insurance program.

43.70.675 - Public health advisory board.

43.70.680 - Volunteers for emergency or disaster assistance.

43.70.690 - State asthma plan.

43.70.700 - Locally grown foods—Women, infant, and children farmers market nutrition program—Fruit and vegetable benefit—Rules.

43.70.705 - Fall prevention program.

43.70.710 - Annual review of medication practices of five jails that use nonpractitioner jail personnel—Noncompliance.

43.70.715 - COVID-19 public health response account.

43.70.720 - Universal vaccine purchase account.

43.70.725 - Health extension program—Dissemination of evidence-based tools and resources—Rules.

43.70.738 - Down syndrome resources—Development.

43.70.740 - Adjudicative proceedings.

43.70.750 - Community assistance referral and education program—Review of certification and training—Recommendations to the legislature.

43.70.765 - Opioid drugs—Warning—Patient education materials.

43.70.770 - State opioid response plan.

43.70.780 - Fruit and vegetable incentives program.

43.70.790 - Health care facility inspection and investigation availability.

43.70.800 - Oversight, consolidation, and standardization—Review.

43.70.810 - Provision of medical information—Dissemination of requirements and authority.

43.70.815 - Environmental health disparities map.

43.70.820 - Environmental justice obligations of the department of health.

43.70.825 - School-based health center program office.

43.70.830 - Lead contamination in drinking water in school buildings—Sampling and testing—Data-sharing agreement.

43.70.835 - Lead contamination in drinking water in school buildings—State-tribal compact schools.

43.70.840 - Lead contamination in drinking water in school buildings—Technical guidance.

43.70.845 - Lead contamination in drinking water in school buildings—Department of health as lead agency—Waiver.

43.70.850 - Suicide-safer homes task force.

43.70.900 - References to the secretary or department of social and health services—1989 1st ex.s. c 9.

43.70.901 - References to the director or department of licensing—1989 1st ex.s. c 9.

43.70.902 - References to the hospital commission—1989 1st ex.s. c 9.

43.70.910 - Effective date—1989 1st ex.s. c 9.

43.70.920 - Severability—1989 1st ex.s. c 9.