Increased Department of Health Oversight and Enforcement Abilities of Acute Care Hospitals

June 15, 2021

To: Chief Executive Officers, Chief Operating Officers, Legal Counsel, and Government Affairs Staff

Please share with appropriate staff

From: Shirley Prasad, JD | Senior Policy Director, Government Affairs
ShirleyP@wsha.org | (206) 216-2550
Subject: Increased Department of Health Oversight and Enforcement Abilities of Acute Care Hospitals

Purpose
This bulletin is to inform acute care hospitals about House Bill 1148, which increases the Washington State Department of Health’s (DOH) oversight and enforcement abilities of acute care hospitals. This is the continuation of the legislature’s efforts to increase DOH oversight and enforcement abilities over health care facilities.

In 2020, a similar bill (House Bill 2426), was passed that applies to freestanding psychiatric hospitals. This issue had a lot of political interest, especially by the Governor and key health care legislators. WSHA worked with the bill sponsors and our members to negotiate a framework that addressed both the concerns legislators had but was also workable for hospitals this includes sufficient guardrails on the new enforcement tools and a meaningful appeals process. The overview section of this bulletin contains more information about the background of this issue.

Applicability/Scope
This bill applies to all acute care hospitals that are licensed under chapter 70.41 RCW. Freestanding psychiatric hospitals that are licensed under chapter 71.12 RCW are already subject to this – now codified in RCW 71.12.710.

Recommendation
Review the bulletin and share with appropriate staff. Please engage with WSHA once the DOH begins its rulemaking process regarding civil fines.

Overview – Key Elements of New Law
Background

In 2019, the Seattle Times published a series of articles highlighting patient safety and quality of care issues at psychiatric hospitals licensed under chapter 71.12 RCW.  In response, the DOH cited a lack of oversight and enforcement tools over the hospitals. As a result, Governor Inslee requested that the legislature address this in the next legislative session. In 2020, the legislature passed House Bill 2426, which expands DOH oversight and enforcement tools for freestanding psychiatric hospitals.

Given that there has also been media coverage of patient safety and quality issues at acute care hospitals, the legislature’s intent was also to expand oversight and enforcement tools for acute care hospitals. This was carried out in 2021, with the enactment of House Bill 1148.

New DOH Oversight and Enforcement Tools

Beginning on July 25, 2021, when the DOH finds that an acute care hospital has failed or refused to comply with applicable statutes or regulations, it may take one or more of the following enforcement actions:

  • Impose reasonable conditions on a license (may include correcting deficiencies within a specific amount of time, training, or hiring a DOH-approved consultant if the hospital does not have internal resources).
  • Assess civil fines of up to $10,000 per violation (total fines not to exceed $1 million). The DOH will establish regulations detailing specific fine amounts in relation to the severity of the non-compliance. Given that acute care hospitals across the state vary, WSHA negotiated that the civil fines must take into consideration the hospital’s size. An acute care hospital may appeal a civil assessment in accordance with RCW 43.70.095.
  • Impose a limited stop placement if the DOH finds an immediate jeopardy to patient health and safety. Immediate jeopardy is defined as when noncompliance places patients at risk for serious injury, harm, impairment or death. The DOH shall conduct a follow-up inspection within five days or within the time requested by the acute care hospital.
  • Impose a stop placement if the DOH finds an immediate jeopardy to patient health and safety and is not confined to a specific patient category or area of the acute care hospital.  Immediate jeopardy is defined as when noncompliance places patients at risk for serious injury, harm, impairment or death. The DOH shall conduct a follow-up inspection within five days or within the time requested by the acute care hospital.
  • Suspend, revoke or refuse to renew a license.

Hospital Fees

The DOH is required to fund any licensure activities through fees rather than with state funds. WSHA advocated for and DOH agreed that the fee methodology must consider a hospital’s operational size and the number of licensed beds.

Appeals Process for Acute Care Hospitals

  • When the DOH imposes conditions on a license, limited stop placement, stop placement, or suspends, revokes or refuses to renew a license, the acute care hospital may appeal the decision. Notice and the hearing will be governed by Washington’s Administrative Procedures Act.
  • The DOH may immediately impose conditions on a license, limited stop placement, stop placement or license suspension if it finds that the acute care hospital’s non-compliance results in immediate jeopardy to patient health and safety, pending an appeal hearing.
  • When the DOH immediately imposes conditions on a license or suspends a license, a hospital is entitled to a show cause hearing within 14 days of making the request. If immediate jeopardy is not found, then the conditions on the license or suspension will be immediately overturned. If immediate jeopardy is found, then the conditions on the license or suspension will remain in effect pending a full hearing.
  • If the DOH sustains the immediate suspension of the license or imposition of conditions on the license, the hospital may request an expedited full hearing on the merits, which must be provided within 90 days of the hospital’s request.

WSHA’s 2021 New Law Implementation Guide
Please visit WSHA’s new law implementation guide online. The Government Affairs team is hard at work preparing resources and information on the high-priority bills that passed in 2021 to help members implement the new laws, as well as links to resources such as this bulletin. In addition, you will find the Government Affairs team’s schedule for the release of upcoming resources on other laws and additional resources for implementation.

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Washington State Hospital Association
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Seattle, WA 98104

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