title: RCW 18.71B.210

text:
(1) The compact shall dissolve effective upon the date of the withdrawal or default of the member state which reduces the membership in the compact to one member state.
(2) Upon the dissolution of the compact, the compact becomes null and void and shall be of no further force or effect, and the business and affairs of the interstate commission shall be concluded and surplus funds shall be distributed in accordance with the bylaws.
[ 2017 c 195 s 22.]

catchline: Dissolution.


doc_type: statute

jurisdiction: wa

title: RCW 18.71B.900

text:
(1) Any state is eligible to become a member state of the compact.
(2) The compact shall become effective and binding upon legislative enactment of the compact into law by no less than seven states. Thereafter, it shall become effective and binding on a state upon enactment of the compact into law by that state.
(3) The governors of nonmember states, or their designees, shall be invited to participate in the activities of the interstate commission on a nonvoting basis prior to adoption of the compact by all states.
(4) The interstate commission may propose amendments to the compact for enactment by the member states. No amendment shall become effective and binding upon the interstate commission and the member states unless and until it is enacted into law by unanimous consent of the member states.
[ 2017 c 195 s 20.]

license: public-domain-government-work

rule_set: Revised Code of Washington

catchline: Member states, effective date, and amendment.

code: rcw

unit: section

court: Washington State Legislature


title: RCW 18.71B.901

text:
(1) The provisions of the compact shall be severable, and if any phrase, clause, sentence, or provision is deemed unenforceable, the remaining provisions of the compact shall be enforceable.
(2) The provisions of the compact shall be liberally construed to effectuate its purposes.
(3) Nothing in the compact shall be construed to prohibit the applicability of other interstate compacts to which the states are members.
[ 2017 c 195 s 23.]

catchline: Severability—Construction.


title: RCW 18.71B.902

text:
(1) Nothing herein prevents the enforcement of any other law of a member state that is not inconsistent with the compact.
(2) All laws in a member state in conflict with the compact are superseded to the extent of the conflict.
(3) All lawful actions of the interstate commission, including all rules and bylaws promulgated by the commission, are binding upon the member states.
(4) All agreements between the interstate commission and the member states are binding in accordance with their terms.
(5) In the event any provision of the compact exceeds the constitutional limits imposed on the legislature of any member state, such provision shall be ineffective to the extent of the conflict with the constitutional provision in question in that member state.
[ 2017 c 195 s 24.]

catchline: Binding effect of compact and other laws.


title: RCW 18.71C.005

text:
In order to strengthen access to medical services, and in recognition of the advances in the delivery of medical services, the participating states of the physician assistant licensure compact have allied in common purpose to develop a comprehensive process that complements the existing authority of state licensing boards to license and discipline physician assistants and seeks to enhance the portability of a license to practice as a physician assistant while safeguarding the safety of patients. This compact allows medical services to be provided by physician assistants, via the mutual recognition of the licensee's qualifying license by other compact participating states. This compact also adopts the prevailing standard for physician assistant licensure and affirms that the practice and delivery of medical services by the physician assistant occurs where the patient is located at the time of the patient encounter, and therefore requires the physician assistant to be under the jurisdiction of the state licensing board where the patient is located. State licensing boards that participate in this compact retain the jurisdiction to impose adverse action against a compact privilege in that state issued to a physician assistant through the procedures of this compact. The physician assistant licensure compact will alleviate burdens for military families by allowing active duty military personnel and their spouses to obtain a compact privilege based on having an unrestricted license in good standing from a participating state.
[ 2024 c 53 s 1.]

catchline: Purpose.


title: RCW 18.71C.010

text:
In this compact:
(1) "Adverse action" means any administrative, civil, equitable, or criminal action permitted by a state's laws which is imposed by a licensing board or other authority against a physician assistant license or license application or compact privilege such as license denial, censure, revocation, suspension, probation, monitoring of the licensee, or restriction on the licensee's practice.
(2) "Compact privilege" means the authorization granted by a remote state to allow a licensee from another participating state to practice as a physician assistant to provide medical services and other licensed activity to a patient located in the remote state under the remote state's laws and regulations.
(3) "Conviction" means a finding by a court that an individual is guilty of a felony or misdemeanor offense through adjudication or entry of a plea of guilt or no contest to the charge by the offender.
(4) "Criminal background check" means the submission of fingerprints or other biometric-based information for a license applicant for the purpose of obtaining that applicant's criminal history record information, as defined in 28 C.F.R. Sec. 20.3(d), from the state's criminal history record repository as defined in 28 C.F.R. Sec. 20.3(f).
(5) "Data system" means the repository of information about licensees, including but not limited to license status and adverse actions, which is created and administered under the terms of this compact.
(6) "Executive committee" means a group of directors and ex officio individuals elected or appointed pursuant to RCW 18.71C.060(6)(b).
(7) "Impaired practitioner" means a physician assistant whose practice is adversely affected by health-related condition(s) that impact their ability to practice.
(8) "Investigative information" means information, records, or documents received or generated by a licensing board pursuant to an investigation.
(9) "Jurisprudence requirement" means the assessment of an individual's knowledge of the laws and rules governing the practice of a physician assistant in a state.
(10) "License" means current authorization by a state, other than authorization pursuant to a compact privilege, for a physician assistant to provide medical services, which would be unlawful without current authorization.
(11) "Licensee" means an individual who holds a license from a state to provide medical services as a physician assistant.
(12) "Licensing board" means any state entity authorized to license and otherwise regulate physician assistants.
(13) "Medical services" means health care services provided for the diagnosis, prevention, treatment, cure or relief of a health condition, injury, or disease, as defined by a state's laws and regulations.
(14) "Model compact" means the model for the physician assistant licensure compact on file with the council of state governments or other entity as designated by the commission.
(15) "Participating state" means a state that has enacted this compact.
(16) "Physician assistant" means an individual who is licensed as a physician assistant in a state. For purposes of this compact, any other title or status adopted by a state to replace the term "physician assistant" shall be deemed synonymous with "physician assistant" and shall confer the same rights and responsibilities to the licensee under the provisions of this compact at the time of its enactment.
(17) "Physician assistant licensure compact commission," "compact commission," or "commission" mean the national administrative body created pursuant to RCW 18.71C.060(1).
(18) "Qualifying license" means an unrestricted license issued by a participating state to provide medical services as a physician assistant.
(19) "Remote state" means a participating state where a licensee who is not licensed as a physician assistant is exercising or seeking to exercise the compact privilege.
(20) "Rule" means a regulation promulgated by an entity that has the force and effect of law.
(21) "Significant investigative information" means investigative information that a licensing board, after an inquiry or investigation that includes notification and an opportunity for the physician assistant to respond if required by state law, has reason to believe is not groundless and, if proven true, would indicate more than a minor infraction.
(22) "State" means any state, commonwealth, district, or territory of the United States.
[ 2024 c 53 s 2.]

catchline: Definitions.


title: RCW 18.71C.020

text:
(1) To participate in this compact, a participating state shall:
(a) License physician assistants;
(b) Participate in the compact commission's data system;
(c) Have a mechanism in place for receiving and investigating complaints against licensees and license applicants;
(d) Notify the commission, in compliance with the terms of this compact and commission rules, of any adverse action against a licensee or license applicant and the existence of significant investigative information regarding a licensee or license applicant;
(e) Fully implement a criminal background check requirement, within a time frame established by commission rule, by its licensing board receiving the results of a criminal background check and reporting to the commission whether the license applicant has been granted a license;
(f) Comply with the rules of the compact commission;
(g) Utilize passage of a recognized national exam such as the national commission on certification of physician assistants' physician assistant national certifying examination as a requirement for physician assistant licensure; and
(h) Grant the compact privilege to a holder of a qualifying license in a participating state.
(2) Nothing in this compact prohibits a participating state from charging a fee for granting the compact privilege.
[ 2024 c 53 s 3.]

catchline: State participation in compact.


title: RCW 18.71C.030

text:
(1) To exercise the compact privilege, a licensee must:
(a) Have graduated from a physician assistant program accredited by the accreditation review commission on education for the physician assistant, inc. or other programs authorized by commission rule;
(b) Hold current national commission on certification of physician assistants' certification;
(c) Have no felony or misdemeanor conviction;
(d) Have never had a controlled substance license, permit, or registration suspended or revoked by a state or by the United States drug enforcement administration;
(e) Have a unique identifier as determined by commission rule;
(f) Hold a qualifying license;
(g) Have had no revocation of a license or limitation or restriction on any license currently held due to an adverse action;
(i) If a licensee has had a limitation or restriction on a license or compact privilege due to an adverse action, two years must have elapsed from the date on which the license or compact privilege is no longer limited or restricted due to the adverse action;
(ii) If a compact privilege has been revoked or is limited or restricted in a participating state for conduct that would not be a basis for disciplinary action in a participating state in which the licensee is practicing or applying to practice under a compact privilege, that participating state shall have the discretion not to consider such action as an adverse action requiring the denial or removal of a compact privilege in that state;
(h) Notify the compact commission that the licensee is seeking the compact privilege in a remote state;
(i) Meet any jurisprudence requirement of a remote state in which the licensee is seeking to practice under the compact privilege and pay any fees applicable to satisfying the jurisprudence requirement; and
(j) Report to the commission any adverse action taken by a nonparticipating state within 30 days after the action is taken.
(2) The compact privilege is valid until the expiration or revocation of the qualifying license unless terminated pursuant to an adverse action. The licensee must also comply with all of the requirements of subsection (1) of this section to maintain the compact privilege in a remote state. If the participating state takes adverse action against a qualifying license, the licensee shall lose the compact privilege in any remote state in which the licensee has a compact privilege until all of the following occur:
(a) The license is no longer limited or restricted; and
(b) Two years have elapsed from the date on which the license is no longer limited or restricted due to the adverse action.
(3) Once a restricted or limited license satisfies the requirements of subsection (2)(a) and (b) of this section, the licensee must meet the requirements of subsection (1) of this section to obtain a compact privilege in any remote state.
(4) For each remote state in which a physician assistant seeks authority to prescribe controlled substances, the physician assistant shall satisfy all requirements imposed by such state in granting or renewing such authority.
[ 2024 c 53 s 4.]

catchline: Compact privilege.


title: RCW 18.71C.040

text:
Upon a licensee's application for a compact privilege, the licensee shall identify to the commission the participating state from which the licensee is applying, in accordance with applicable rules adopted by the commission, and subject to the following requirements:
(1) When applying for a compact privilege, the licensee shall provide the commission with the address of the licensee's primary residence and thereafter shall immediately report to the commission any change in the address of the licensee's primary residence.
(2) When applying for a compact privilege, the licensee is required to consent to accept service of process by mail at the licensee's primary residence on file with the commission with respect to any action brought against the licensee by the commission or a participating state, including a subpoena, with respect to any action brought or investigation conducted by the commission or a participating state.
[ 2024 c 53 s 5.]

catchline: Designation of state for compact privilege.


title: RCW 18.71C.050

text:
(1) A participating state in which a licensee is licensed shall have exclusive power to impose adverse action against the qualifying license issued by that participating state.
(2)(a) In addition to the other powers conferred by state law, a remote state shall have the authority, in accordance with existing state due process law, to do all of the following:
(i) Take adverse action against a physician assistant's compact privilege within that state to remove a licensee's compact privilege or take other action necessary under applicable law to protect the health and safety of its citizens;
(ii) Issue subpoenas for both hearings and investigations that require the attendance and testimony of witnesses as well as the production of evidence. Subpoenas issued by a licensing board in a participating state for the attendance and testimony of witnesses or the production of evidence from another participating state shall be enforced in the latter state by any court of competent jurisdiction, according to the practice and procedure of that court applicable to subpoenas issued in proceedings pending before it. The issuing authority shall pay any witness fees, travel expenses, mileage, and other fees required by the service statutes of the state in which the witnesses or evidence are located.
(b) Notwithstanding (a)(ii) of this subsection, subpoenas may not be issued by a participating state to gather evidence of conduct in another state that is lawful in that other state for the purpose of taking adverse action against a licensee's compact privilege or application for a compact privilege in that participating state.
(c) Nothing in this compact authorizes a participating state to impose discipline against a physician assistant's compact privilege or to deny an application for a compact privilege in that participating state for the individual's otherwise lawful practice in another state.
(3) For purposes of taking adverse action, the participating state which issued the qualifying license shall give the same priority and effect to reported conduct received from any other participating state as it would if the conduct had occurred within the participating state which issued the qualifying license. In so doing, that participating state shall apply its own state laws to determine appropriate action.
(4) A participating state, if otherwise permitted by state law, may recover from the affected physician assistant the costs of investigations and disposition of cases resulting from any adverse action taken against that physician assistant.
(5) A participating state may take adverse action based on the factual findings of a remote state, provided that the participating state follows its own procedures for taking the adverse action.
(6) Joint investigations.
(a) In addition to the authority granted to a participating state by its respective state physician assistant laws and regulations or other applicable state law, any participating state may participate with other participating states in joint investigations of licensees.
(b) Participating states shall share any investigative, litigation, or compliance materials in furtherance of any joint or individual investigation initiated under this compact.
(7) If an adverse action is taken against a physician assistant's qualifying license, the physician assistant's compact privilege in all remote states shall be deactivated until two years have elapsed after all restrictions have been removed from the state license. All disciplinary orders by the participating state which issued the qualifying license that impose adverse action against a physician assistant's license shall include a statement that the physician assistant's compact privilege is deactivated in all participating states during the pendency of the order.
(8) If any participating state takes adverse action, it promptly shall notify the administrator of the data system.
[ 2024 c 53 s 6.]

catchline: Adverse actions.


title: RCW 18.71C.060

text:
(1) The participating states hereby create and establish a joint government agency and national administrative body known as the physician assistant licensure compact commission. The commission is an instrumentality of the compact states acting jointly and not an instrumentality of any one state. The commission shall come into existence on or after the effective date of the compact as set forth in RCW 18.71C.900(1).
(2) Membership, voting, and meetings.
(a) Each participating state shall have and be limited to one delegate selected by that participating state's licensing board or, if the state has more than one licensing board, selected collectively by the participating state's licensing boards.
(b) The delegate shall be either:
(i) A current physician assistant, physician, or public member of a licensing board or physician assistant council/committee; or
(ii) An administrator of a licensing board.
(c) Any delegate may be removed or suspended from office as provided by the laws of the state from which the delegate is appointed.
(d) The participating state licensing board shall fill any vacancy occurring in the commission within 60 days.
(e) Each delegate shall be entitled to one vote on all matters voted on by the commission and shall otherwise have an opportunity to participate in the business and affairs of the commission. A delegate shall vote in person or by such other means as provided in the bylaws. The bylaws may provide for delegates' participation in meetings by telecommunications, videoconference, or other means of communication.
(f) The commission shall meet at least once during each calendar year. Additional meetings shall be held as set forth in this compact and the bylaws.
(g) The commission shall establish by rule a term of office for delegates.
(3) The commission shall have the following powers and duties:
(a) Establish a code of ethics for the commission;
(b) Establish the fiscal year of the commission;
(c) Establish fees;
(d) Establish bylaws;
(e) Maintain its financial records in accordance with the bylaws;
(f) Meet and take such actions as are consistent with the provisions of this compact and the bylaws;
(g) Promulgate rules to facilitate and coordinate implementation and administration of this compact. The rules shall have the force and effect of law and shall be binding in all participating states;
(h) Bring and prosecute legal proceedings or actions in the name of the commission, provided that the standing of any state licensing board to sue or be sued under applicable law shall not be affected;
(i) Purchase and maintain insurance and bonds;
(j) Borrow, accept, or contract for services of personnel including, but not limited to, employees of a participating state;
(k) Hire employees and engage contractors, elect or appoint officers, fix compensation, define duties, grant such individuals appropriate authority to carry out the purposes of this compact, and establish the commission's personnel policies and programs relating to conflicts of interest, qualifications of personnel, and other related personnel matters;
(l) Accept any and all appropriate donations and grants of money, equipment, supplies, materials, and services, and receive, utilize, and dispose of the same; provided that at all times the commission shall avoid any appearance of impropriety or conflict of interest;
(m) Lease, purchase, accept appropriate gifts or donations of, or otherwise own, hold, improve, or use, any property, real, personal, or mixed; provided that at all times the commission shall avoid any appearance of impropriety;
(n) Sell, convey, mortgage, pledge, lease, exchange, abandon, or otherwise dispose of any property real, personal, or mixed;
(o) Establish a budget and make expenditures;
(p) Borrow money;
(q) Appoint committees, including standing committees composed of members, state regulators, state legislators or their representatives, and consumer representatives, and such other interested persons as may be designated in this compact and the bylaws;
(r) Provide and receive information from, and cooperate with, law enforcement agencies;
(s) Elect a chair, vice chair, secretary, and treasurer and such other officers of the commission as provided in the commission's bylaws;
(t) Reserve for itself, in addition to those reserved exclusively to the commission under the compact, powers that the executive committee may not exercise;
(u) Approve or disapprove a state's participation in the compact based upon its determination as to whether the state's compact legislation departs in a material manner from the model compact language;
(v) Prepare and provide to the participating states an annual report; and
(w) Perform such other functions as may be necessary or appropriate to achieve the purposes of this compact consistent with the state regulation of physician assistant licensure and practice.
(4) Meetings of the commission.
(a) All meetings of the commission that are not closed pursuant to this subsection shall be open to the public. Notice of public meetings shall be posted on the commission's website at least 30 days prior to the public meeting.
(b) Notwithstanding (a) of this subsection, the commission may convene a public meeting by providing at least 24 hours prior notice on the commission's website, and any other means as provided in the commission's rules, for any of the reasons it may dispense with notice of proposed rule making under RCW 18.71C.080(12).
(c) The commission may convene in a closed, nonpublic meeting or nonpublic part of a public meeting to receive legal advice or to discuss:
(i) Noncompliance of a participating state with its obligations under this compact;
(ii) The employment, compensation, discipline or other matters, practices, or procedures related to specific employees or other matters related to the commission's internal personnel practices and procedures;
(iii) Current, threatened, or reasonably anticipated litigation;
(iv) Negotiation of contracts for the purchase, lease, or sale of goods, services, or real estate;
(v) Accusing any person of a crime or formally censuring any person;
(vi) Disclosure of trade secrets or commercial or financial information that is privileged or confidential;
(vii) Disclosure of information of a personal nature where disclosure would constitute a clearly unwarranted invasion of personal privacy;
(viii) Disclosure of investigative records compiled for law enforcement purposes;
(ix) Disclosure of information related to any investigative reports prepared by or on behalf of or for use of the commission or other committee charged with responsibility of investigation or determination of compliance issues pursuant to this compact;
(x) Legal advice; or
(xi) Matters specifically exempted from disclosure by federal or participating states' statutes.
(d) If a meeting, or portion of a meeting, is closed pursuant to this provision, the chair of the meeting or the chair's designee shall certify that the meeting or portion of the meeting may be closed and shall reference each relevant exempting provision.
(e) The commission shall keep minutes that fully and clearly describe all matters discussed in a meeting and shall provide a full and accurate summary of actions taken, including a description of the views expressed. All documents considered in connection with an action shall be identified in such minutes. All minutes and documents of a closed meeting shall remain under seal, subject to release by a majority vote of the commission or order of a court of competent jurisdiction.
(5) Financing of the commission.
(a) The commission shall pay, or provide for the payment of, the reasonable expenses of its establishment, organization, and ongoing activities.
(b) The commission may accept any and all appropriate revenue sources, donations, and grants of money, equipment, supplies, materials, and services.
(c) The commission may levy on and collect an annual assessment from each participating state and may impose compact privilege fees on licensees of participating states to whom a compact privilege is granted to cover the cost of the operations and activities of the commission and its staff, which must be in a total amount sufficient to cover its annual budget as approved by the commission each year for which revenue is not provided by other sources. The aggregate annual assessment amount levied on participating states shall be allocated based upon a formula to be determined by commission rule.
(i) A compact privilege expires when the licensee's qualifying license in the participating state from which the licensee applied for the compact privilege expires.
(ii) If the licensee terminates the qualifying license through which the licensee applied for the compact privilege before its scheduled expiration, and the licensee has a qualifying license in another participating state, the licensee shall inform the commission that it is changing to that participating state the participating state through which it applies for a compact privilege and pay to the commission any compact privilege fee required by commission rule.
(d) The commission shall not incur obligations of any kind prior to securing the funds adequate to meet the same; nor shall the commission pledge the credit of any of the participating states, except by and with the authority of the participating state.
(e) The commission shall keep accurate accounts of all receipts and disbursements. The receipts and disbursements of the commission shall be subject to the financial review and accounting procedures established under its bylaws. All receipts and disbursements of funds handled by the commission shall be subject to an annual financial review by a certified or licensed public accountant, and the report of the financial review shall be included in and become part of the annual report of the commission.
(6) The executive committee.
(a) The executive committee shall have the power to act on behalf of the commission according to the terms of this compact and commission rules.
(b) The executive committee shall be composed of nine members:
(i) Seven voting members who are elected by the commission from the current membership of the commission;
(ii) One ex officio, nonvoting member from a recognized national physician assistant professional association; and
(iii) One ex officio, nonvoting member from a recognized national physician assistant certification organization.
(c) The ex officio members will be selected by their respective organizations.
(d) The commission may remove any member of the executive committee as provided in its bylaws.
(e) The executive committee shall meet at least annually.
(f) The executive committee shall have the following duties and responsibilities:
(i) Recommend to the commission changes to the commission's rules or bylaws, changes to this compact legislation, fees to be paid by compact participating states such as annual dues, and any commission compact fee charged to licensees for the compact privilege;
(ii) Ensure compact administration services are appropriately provided, contractual or otherwise;
(iii) Prepare and recommend the budget;
(iv) Maintain financial records on behalf of the commission;
(v) Monitor compact compliance of participating states and provide compliance reports to the commission;
(vi) Establish additional committees as necessary;
(vii) Exercise the powers and duties of the commission during the interim between commission meetings, except for issuing proposed rule making or adopting commission rules or bylaws, or exercising any other powers and duties exclusively reserved to the commission by the commission's rules; and
(viii) Perform other duties as provided in the commission's rules or bylaws.
(g) All meetings of the executive committee at which it votes or plans to vote on matters in exercising the powers and duties of the commission shall be open to the public and public notice of such meetings shall be given as public meetings of the commission are given.
(h) The executive committee may convene in a closed, nonpublic meeting for the same reasons that the commission may convene in a nonpublic meeting as set forth in subsection (4)(c) of this section and shall announce the closed meeting as the commission is required to under subsection (4)(d) of this section and keep minutes of the closed meeting as the commission is required to under subsection (4)(e) of this section.
(7) Qualified immunity, defense, and indemnification.
(a) The members, officers, executive director, employees, and representatives of the commission shall be immune from suit and liability, both personally and in their official capacity, for any claim for damage to or loss of property or personal injury or other civil liability caused by or arising out of any actual or alleged act, error, or omission that occurred, or that the person against whom the claim is made had a reasonable basis for believing occurred within the scope of commission employment, duties, or responsibilities; provided that nothing in this subsection (7)(a) shall be construed to protect any such person from suit or liability for any damage, loss, injury, or liability caused by the intentional or willful or wanton misconduct of that person. The procurement of insurance of any type by the commission shall not in any way compromise or limit the immunity granted hereunder.
(b) The commission shall defend any member, officer, executive director, employee, and representative of the commission in any civil action seeking to impose liability arising out of any actual or alleged act, error, or omission that occurred within the scope of commission employment, duties, or responsibilities, or as determined by the commission that the person against whom the claim is made had a reasonable basis for believing occurred within the scope of commission employment, duties, or responsibilities; provided that nothing herein shall be construed to prohibit that person from retaining their own counsel at their own expense; and provided further, that the actual or alleged act, error, or omission did not result from that person's intentional or willful or wanton misconduct.
(c) The commission shall indemnify and hold harmless any member, officer, executive director, employee, and representative of the commission for the amount of any settlement or judgment obtained against that person arising out of any actual or alleged act, error, or omission that occurred within the scope of commission employment, duties, or responsibilities, or that such person had a reasonable basis for believing occurred within the scope of commission employment, duties, or responsibilities; provided that the actual or alleged act, error, or omission did not result from the intentional or willful or wanton misconduct of that person.
(d) Venue is proper and judicial proceedings by or against the commission shall be brought solely and exclusively in a court of competent jurisdiction where the principal office of the commission is located. The commission may waive venue and jurisdictional defenses in any proceedings as authorized by commission rules.
(e) Nothing herein shall be construed as a limitation on the liability of any licensee for professional malpractice or misconduct, which shall be governed solely by any other applicable state laws.
(f) Nothing herein shall be construed to designate the venue or jurisdiction to bring actions for alleged acts of malpractice, professional misconduct, negligence, or other such civil action pertaining to the practice of a physician assistant. All such matters shall be determined exclusively by state law other than this compact.
(g) Nothing in this compact shall be interpreted to waive or otherwise abrogate a participating state's state action immunity or state action affirmative defense with respect to antitrust claims under the Sherman act, Clayton act, or any other state or federal antitrust or anticompetitive law or regulation.
(h) Nothing in this compact shall be construed to be a waiver of sovereign immunity by the participating states or by the commission.
[ 2024 c 53 s 7.]

catchline: Compact commission—Establishment—Organization—Powers and duties—Liability.


title: RCW 18.71C.070

text:
(1) The commission shall provide for the development, maintenance, operation, and utilization of a coordinated data and reporting system containing licensure, adverse action, and the reporting of the existence of significant investigative information on all licensed physician assistants and applicants denied a license in participating states.
(2) Notwithstanding any other state law to the contrary, a participating state shall submit a uniform data set to the data system on all physician assistants to whom this compact is applicable, utilizing a unique identifier, as required by the rules of the commission, including:
(a) Identifying information;
(b) Licensure data;
(c) Adverse actions against a license or compact privilege;
(d) Any denial of application for licensure, and the reason(s) for such denial, excluding the reporting of any criminal history record information where prohibited by law;
(e) The existence of significant investigative information; and
(f) Other information that may facilitate the administration of this compact, as determined by the rules of the commission.
(3) Significant investigative information pertaining to a licensee in any participating state shall only be available to other participating states.
(4) The commission shall promptly notify all participating states of any adverse action taken against a licensee or an individual applying for a license that has been reported to it. This adverse action information shall be available to any other participating state.
(5) Participating states contributing information to the data system may, in accordance with state or federal law, designate information that may not be shared with the public without the express permission of the contributing state. Notwithstanding any such designation, such information shall be reported to the commission through the data system.
(6) Any information submitted to the data system that is subsequently expunged pursuant to federal law or the laws of the participating state contributing the information shall be removed from the data system upon reporting of such by the participating state to the commission.
(7) The records and information provided to a participating state pursuant to this compact or through the data system, when certified by the commission or an agent thereof, shall constitute the authenticated business records of the commission, and shall be entitled to any associated hearsay exception in any relevant judicial, quasi-judicial, or administrative proceedings in a participating state.
[ 2024 c 53 s 8.]

catchline: Data system.


title: RCW 18.71C.080

text:
(1) The commission shall exercise its rule-making powers pursuant to the criteria set forth in this section and the rules adopted thereunder. Commission rules shall become binding as of the date specified by the commission for each rule.
(2) The commission shall promulgate reasonable rules in order to effectively and efficiently implement and administer this compact and achieve its purposes. A commission rule shall be invalid and have no force or effect only if a court of competent jurisdiction holds that the rule is invalid because the commission exercised its rule-making authority in a manner that is beyond the scope of the purposes of this compact, or the powers granted hereunder, or based upon another applicable standard of review.
(3) The rules of the commission shall have the force of law in each participating state, provided however that where the rules of the commission conflict with the laws of the participating state that establish the medical services a physician assistant may perform in the participating state, as held by a court of competent jurisdiction, the rules of the commission shall be ineffective in that state to the extent of the conflict.
(4) If a majority of the legislatures of the participating states rejects a commission rule, by enactment of a statute or resolution in the same manner used to adopt this compact within four years of the date of adoption of the rule, then such rule shall have no further force and effect in any participating state or to any state applying to participate in the compact.
(5) Commission rules shall be adopted at a regular or special meeting of the commission.
(6) Prior to promulgation and adoption of a final rule or rules by the commission, and at least 30 days in advance of the meeting at which the rule will be considered and voted upon, the commission shall file a notice of proposed rule making:
(a) On the website of the commission or other publicly accessible platform; and
(b) To persons who have requested notice of the commission's notices of proposed rule making; and
(c) In such other way(s) as the commission may by rule specify.
(7) The notice of proposed rule making shall include:
(a) The time, date, and location of the public hearing on the proposed rule and the proposed time, date, and location of the meeting in which the proposed rule will be considered and voted upon;
(b) The text of the proposed rule and the reason for the proposed rule;
(c) A request for comments on the proposed rule from any interested person and the date by which written comments must be received; and
(d) The manner in which interested persons may submit notice to the commission of their intention to attend the public hearing or provide any written comments.
(8) Prior to adoption of a proposed rule, the commission shall allow persons to submit written data, facts, opinions, and arguments, which shall be made available to the public.
(9) If the hearing is to be held via electronic means, the commission shall publish the mechanism for access to the electronic hearing.
(a) All persons wishing to be heard at the hearing shall[,] as directed in the notice of proposed rule making, not less than five business days before the scheduled date of the hearing, notify the commission of their desire to appear and testify at the hearing.
(b) Hearings shall be conducted in a manner providing each person who wishes to comment a fair and reasonable opportunity to comment orally or in writing.
(c) All hearings shall be recorded. A copy of the recording and the written comments, data, facts, opinions, and arguments received in response to the proposed rule making shall be made available to a person upon request.
(d) Nothing in this section shall be construed as requiring a separate hearing on each proposed rule. Proposed rules may be grouped for the convenience of the commission at hearings required by this section.
(10) Following the public hearing[,] the commission shall consider all written and oral comments timely received.
(11) The commission shall, by majority vote of all delegates, take final action on the proposed rule and shall determine the effective date of the rule, if adopted, based on the rule-making record and the full text of the rule.
(a) If adopted, the rule shall be posted on the commission's website.
(b) The commission may adopt changes to the proposed rule provided the changes do not enlarge the original purpose of the proposed rule.
(c) The commission shall provide on its website an explanation of the reasons for substantive changes made to the proposed rule as well as reasons for substantive changes not made that were recommended by commenters.
(d) The commission shall determine a reasonable effective date for the rule. Except for an emergency as provided in subsection (12) of this section, the effective date of the rule shall be no sooner than 30 days after the commission issued the notice that it adopted the rule.
(12) Upon determination that an emergency exists, the commission may consider and adopt an emergency rule with 24 hours' prior notice, without the opportunity for comment, or hearing, provided that the usual rule-making procedures provided in this compact and in this section shall be retroactively applied to the rule as soon as reasonably possible, in no event later than 90 days after the effective date of the rule. For the purposes of this provision, an emergency rule is one that must be adopted immediately by the commission in order to:
(a) Meet an imminent threat to public health, safety, or welfare;
(b) Prevent a loss of commission or participating state funds;
(c) Meet a deadline for the promulgation of a commission rule that is established by federal law or rule; or
(d) Protect public health and safety.
(13) The commission or an authorized committee of the commission may direct revisions to a previously adopted commission rule for purposes of correcting typographical errors, errors in format, errors in consistency, or grammatical errors. Public notice of any revisions shall be posted on the website of the commission. The revision shall be subject to challenge by any person for a period of 30 days after posting. The revision may be challenged only on grounds that the revision results in a material change to a rule. A challenge shall be made as set forth in the notice of revisions and delivered to the commission prior to the end of the notice period. If no challenge is made, the revision will take effect without further action. If the revision is challenged, the revision may not take effect without the approval of the commission.
(14) No participating state's rule-making requirements shall apply under this compact.
[ 2024 c 53 s 9.]

catchline: Rule making.


title: RCW 18.71C.090

text:
(1) Oversight.
(a) The executive and judicial branches of state government in each participating state shall enforce this compact and take all actions necessary and appropriate to implement the compact.
(b) Venue is proper and judicial proceedings by or against the commission shall be brought solely and exclusively in a court of competent jurisdiction where the principal office of the commission is located. The commission may waive venue and jurisdictional defenses to the extent it adopts or consents to participate in alternative dispute resolution proceedings. Nothing herein shall affect or limit the selection or propriety of venue in any action against a licensee for professional malpractice, misconduct, or any such similar matter.
(c) The commission shall be entitled to receive service of process in any proceeding regarding the enforcement or interpretation of the compact or the commission's rules and shall have standing to intervene in such a proceeding for all purposes. Failure to provide the commission with service of process shall render a judgment or order in such proceeding void as to the commission, this compact, or commission rules.
(2) Default, technical assistance, and termination.
(a) If the commission determines that a participating state has defaulted in the performance of its obligations or responsibilities under this compact or the commission rules, the commission shall provide written notice to the defaulting state and other participating states. The notice shall describe the default, the proposed means of curing the default, and any other action that the commission may take and shall offer remedial training and specific technical assistance regarding the default.
(b) If a state in default fails to cure the default, the defaulting state may be terminated from this compact upon an affirmative vote of a majority of the delegates of the participating states, and all rights, privileges, and benefits conferred by this compact upon such state may be terminated on the effective date of termination. A cure of the default does not relieve the offending state of obligations or liabilities incurred during the period of default.
(c) Termination of participation in this compact shall be imposed only after all other means of securing compliance have been exhausted. Notice of intent to suspend or terminate shall be given by the commission to the governor, the majority and minority leaders of the defaulting state's legislature, and to the licensing board(s) of each of the participating states.
(d) A state that has been terminated is responsible for all assessments, obligations, and liabilities incurred through the effective date of termination, including obligations that extend beyond the effective date of termination.
(e) The commission shall not bear any costs related to a state that is found to be in default or that has been terminated from this compact, unless agreed upon in writing between the commission and the defaulting state.
(f) The defaulting state may appeal its termination from the compact by the commission by petitioning the United States district court for the District of Columbia or the federal district where the commission has its principal offices. The prevailing member shall be awarded all costs of such litigation, including reasonable attorneys' fees.
(g) Upon the termination of a state's participation in the compact, the state shall immediately provide notice to all licensees within that state of such termination:
(i) Licensees who have been granted a compact privilege in that state shall retain the compact privilege for 180 days following the effective date of such termination.
(ii) Licensees who are licensed in that state who have been granted a compact privilege in a participating state shall retain the compact privilege for 180 days unless the licensee also has a qualifying license in a participating state or obtains a qualifying license in a participating state before the 180-day period ends, in which case the compact privilege shall continue.
(3) Dispute resolution.
(a) Upon request by a participating state, the commission shall attempt to resolve disputes related to this compact that arise among participating states and between participating and nonparticipating states.
(b) The commission shall promulgate a rule providing for both mediation and binding dispute resolution for disputes as appropriate.
(4) Enforcement.
(a) The commission, in the reasonable exercise of its discretion, shall enforce the provisions of this compact and rules of the commission.
(b) If compliance is not secured after all means to secure compliance have been exhausted, by majority vote, the commission may initiate legal action in the United States district court for the District of Columbia or the federal district where the commission has its principal offices, against a participating state in default to enforce compliance with the provisions of this compact and the commission's promulgated rules and bylaws. The relief sought may include both injunctive relief and damages. In the event judicial enforcement is necessary, the prevailing party shall be awarded all costs of such litigation, including reasonable attorneys' fees.
(c) The remedies herein shall not be the exclusive remedies of the commission. The commission may pursue any other remedies available under federal or state law.
(5) Legal action against the commission.
(a) Participating states may initiate legal action against the commission in the United States district court for the District of Columbia or the federal district where the commission has its principal offices to enforce compliance with the provisions of the compact and its rules. The relief sought may include both injunctive relief and damages. In the event judicial enforcement is necessary, the prevailing party shall be awarded all costs of such litigation, including reasonable attorneys' fees.
(b) No person other than a participating state shall enforce this compact against the commission.
[ 2024 c 53 s 10.]


title: RCW 18.71C.900

text:
(1) This compact shall come into effect on the date on which this compact statute is enacted into law in the seventh participating state.
(a) On or after the effective date of the compact, the commission shall convene and review the enactment of each of the states that enacted the compact prior to the commission convening ("charter participating states") to determine if the statute enacted by each such charter participating state is materially different than the model compact.
(i) A charter participating state whose enactment is found to be materially different from the model compact shall be entitled to the default process set forth in RCW 18.71C.090(2).
(ii) If any participating state later withdraws from the compact or its participation is terminated, the commission shall remain in existence and the compact shall remain in effect even if the number of participating states should be less than seven. Participating states enacting the compact subsequent to the commission convening shall be subject to the process set forth in RCW 18.71C.060(3)(u) to determine if their enactments are materially different from the model compact and whether they qualify for participation in the compact.
(b) Participating states enacting the compact subsequent to the seven initial charter participating states shall be subject to the process set forth in RCW 18.71C.060(3)(u) to determine if their enactments are materially different from the model compact and whether they qualify for participation in the compact.
(c) All actions taken for the benefit of the commission or in furtherance of the purposes of the administration of the compact prior to the effective date of the compact or the commission coming into existence shall be considered to be actions of the commission unless specifically repudiated by the commission.
(2) Any state that joins this compact shall be subject to the commission's rules and bylaws as they exist on the date on which this compact becomes law in that state. Any rule that has been previously adopted by the commission shall have the full force and effect of law on the day this compact becomes law in that state.
(3) Any participating state may withdraw from this compact by enacting a statute repealing the same.
(a) A participating state's withdrawal shall not take effect until 180 days after enactment of the repealing statute. During this 180-day period, all compact privileges that were in effect in the withdrawing state and were granted to licensees licensed in the withdrawing state shall remain in effect. If any licensee licensed in the withdrawing state is also licensed in another participating state or obtains a license in another participating state within the 180 days, the licensee's compact privileges in other participating states shall not be affected by the passage of the 180 days.
(b) Withdrawal shall not affect the continuing requirement of the state licensing board(s) of the withdrawing state to comply with the investigative and adverse action reporting requirements of this compact prior to the effective date of withdrawal.
(c) Upon the enactment of a statute withdrawing a state from this compact, the state shall immediately provide notice of such withdrawal to all licensees within that state. Such withdrawing state shall continue to recognize all licenses granted pursuant to this compact for a minimum of 180 days after the date of such notice of withdrawal.
(4) Nothing contained in this compact shall be construed to invalidate or prevent any physician assistant licensure agreement or other cooperative arrangement between participating states and between a participating state and nonparticipating state that does not conflict with the provisions of this compact.
(5) This compact may be amended by the participating states. No amendment to this compact shall become effective and binding upon any participating state until it is enacted materially in the same manner into the laws of all participating states as determined by the commission.
[ 2024 c 53 s 11.]

catchline: Effective date.


title: RCW 18.71C.901

text:
(1) This compact and the commission's rule-making authority shall be liberally construed so as to effectuate the purposes, and the implementation and administration of the compact. Provisions of the compact expressly authorizing or requiring the promulgation of rules shall not be construed to limit the commission's rule-making authority solely for those purposes.
(2) The provisions of this compact shall be severable and if any phrase, clause, sentence, or provision of this compact is held by a court of competent jurisdiction to be contrary to the constitution of any participating state, a state seeking participation in the compact, or of the United States, or the applicability thereof to any government, agency, person, or circumstance is held to be unconstitutional by a court of competent jurisdiction, the validity of the remainder of this compact and the applicability thereof to any other government, agency, person, or circumstance shall not be affected thereby.
(3) Notwithstanding subsection (2) of this section, the commission may deny a state's participation in the compact or, in accordance with the requirements of RCW 18.71C.090(2), terminate a participating state's participation in the compact, if it determines that a constitutional requirement of a participating state is, or would be with respect to a state seeking to participate in the compact, a material departure from the compact. Otherwise, if this compact shall be held to be contrary to the constitution of any participating state, the compact shall remain in full force and effect as to the remaining participating states and in full force and effect as to the participating state affected as to all severable matters.
[ 2024 c 53 s 12.]

catchline: Construction—Severability.


title: RCW 18.71C.902

text:
(1) Nothing herein prevents the enforcement of any other law of a participating state that is not inconsistent with this compact.
(2) Any laws in a participating state in conflict with this compact are superseded to the extent of the conflict.
(3) All agreements between the commission and the participating states are binding in accordance with their terms.
[ 2024 c 53 s 13.]

catchline: Binding effect of compact.


title: RCW 18.71D.010

text:
The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.
(1) "Anesthesiologist" means an actively practicing, board-eligible physician licensed under chapter 18.71, 18.71B, or 18.57 RCW who has completed a residency or equivalent training in anesthesiology.
(2) "Anesthesiologist assistant" means a person who is licensed by the commission to assist in developing and implementing anesthesia care plans for patients under the supervision of an anesthesiologist or group of anesthesiologists approved by the commission to supervise such assistant.
(3) "Assists" means the anesthesiologist assistant personally performs those duties and responsibilities delegated by the anesthesiologist. Delegated services must be consistent with the delegating anesthesiologist's education, training, experience, and active practice. Delegated services must be of the type that a reasonable and prudent anesthesiologist would find within the scope of sound medical judgment to delegate.
(4) "Commission" means the Washington medical commission.
(5) "Practice medicine" has the meaning defined in RCW 18.71.011.
(6) "Secretary" means the secretary of health or the secretary's designee.
(7) "Supervision" means the immediate availability of the medically directing anesthesiologist for consultation and direction of the activities of the anesthesiologist assistant. A medically directing anesthesiologist is immediately available if they are in physical proximity that allows the anesthesiologist to reestablish direct contact with the patient to meet medical needs and any urgent or emergent clinical problems, and personally participating in the most demanding procedures of the anesthesia plan including, if applicable, induction and emergence. These responsibilities may also be met through coordination among anesthesiologists of the same group or department.
[ 2024 c 362 s 1.]


title: RCW 18.71D.020

text:
(1) The commission shall adopt rules fixing the qualifications and the educational and training requirements for licensure as an anesthesiologist assistant. The requirements shall include completion of an anesthesiologist assistant program accredited by the commission on accreditation of allied health education programs, or successor organization, and within one year successfully taking and passing an examination administered by the national commission for the certification of anesthesiologist assistants or other examination approved by the commission.
(2) Applicants for licensure shall file an application with the commission on a form prepared by the secretary with the approval of the commission, detailing the education, training, and experience of the applicant and such other information as the commission may require. The application shall be accompanied by a fee determined by the secretary as provided in RCW 43.70.250 and 43.70.280. Each applicant shall furnish proof satisfactory to the commission of the following:
(a) That the applicant has completed an accredited anesthesiologist assistant program approved by the commission and is eligible to take the examination approved by the commission; and
(b) That the applicant is physically and mentally capable of practicing as an anesthesiologist assistant with reasonable skill and safety. The commission may require an applicant to submit to such examination or examinations as it deems necessary to determine an applicant's physical or mental capability, or both, to safely practice as an anesthesiologist assistant.
(3)(a) The commission may approve, deny, or take other disciplinary action upon the application for a license as provided in the uniform disciplinary act, chapter 18.130 RCW.
(b) The license shall be renewed as determined under RCW 43.70.250 and 43.70.280. The commission shall request licensees to submit information about their current professional practice at the time of license renewal and licensees must provide the information requested.
(4) No person shall practice as an anesthesiologist assistant or represent that they are a "certified anesthesiologist assistant" or "anesthesiologist assistant" or "C.A.A." or "A.A." without a license granted by the commission.
[ 2024 c 362 s 2.]


title: RCW 18.71D.030

text:
(1) The commission shall adopt rules establishing the requirements and limitations on the practice by and supervision of anesthesiologist assistants, including the number of anesthesiologist assistants an anesthesiologist may supervise concurrently. Unless approved by the commission, an anesthesiologist may not concurrently supervise more than four specific, individual anesthesiologist assistants at any one time.
(2) The commission may adopt rules for the arrangement of other anesthesiologists to serve as backup or on-call supervising anesthesiologists for multiple anesthesiologist assistants.
[ 2024 c 362 s 3.]

catchline: Rules establishing scope of practice—Supervision.


title: RCW 18.71D.040

text:
(1) An anesthesiologist assistant may not exceed the scope of their supervising anesthesiologist's practice and may assist with those duties and responsibilities delegated to them by the supervising anesthesiologist, and for which they are competent to assist with based on their education, training, and experience. Duties which an anesthesiologist may delegate to an anesthesiologist assistant include but are not limited to:
(a) Assisting with preoperative anesthetic evaluations, postoperative anesthetic evaluations, and patient progress notes, all to be cosigned by the supervising anesthesiologist within 24 hours;
(b) Administering and assisting with preoperative consultations;
(c) Under the supervising anesthesiologist's consultation and direction, order perioperative pharmaceutical agents, medications, and fluids, to be used only at the facility where ordered, including but not limited to controlled substances, which may be administered prior to the cosignature of the supervising anesthesiologist. The supervising anesthesiologist may review and if required by the facility or institutional policy must cosign these orders in a timely manner;
(d) Changing or discontinuing a medical treatment plan, after consultation with the supervising anesthesiologist;
(e) Calibrating anesthesia delivery systems and obtaining and interpreting information from the systems and monitors, in consultation with an anesthesiologist;
(f) Assisting the supervising anesthesiologist with the implementation of medically accepted monitoring techniques;
(g) Assisting with basic and advanced airway interventions, including but not limited to endotracheal intubation, laryngeal mask insertion, and other advanced airways techniques;
(h) Establishing peripheral intravenous lines, including subcutaneous lidocaine use;
(i) Establishing radial and dorsalis pedis arterial lines;
(j) Assisting with general anesthesia, including induction, maintenance, and emergence;
(k) Assisting with procedures associated with general anesthesia, such as but not limited to gastric intubation;
(l) Administering intermittent vasoactive drugs and starting and titrating vasoactive infusions for the treatment of patient responses to anesthesia;
(m) Assisting with spinal and intravenous regional anesthesia;
(n) Maintaining and managing established neuraxial epidurals and regional anesthesia;
(o) Assisting with monitored anesthesia care;
(p) Evaluating and managing patient controlled analgesia, epidural catheters, and peripheral nerve catheters;
(q) Obtaining venous and arterial blood samples;
(r) Assisting with, ordering, and interpreting appropriate preoperative, point of care, intraoperative, or postoperative diagnostic tests or procedures as authorized by the supervising anesthesiologist;
(s) Obtaining and administering perioperative anesthesia and related pharmaceutical agents including intravenous fluids and blood products;
(t) Participating in management of the patient while in the preoperative suite and recovery area;
(u) Providing assistance to a cardiopulmonary resuscitation team in response to a life-threatening situation;
(v) Participating in administrative, research, and clinical teaching activities as authorized by the supervising anesthesiologist; and
(w) Assisting with such other tasks not prohibited by law under the supervision of a licensed anesthesiologist that an anesthesiologist assistant has been trained and is proficient to assist with.
(2) Nothing in this section shall be construed to prevent an anesthesiologist assistant from having access to and being able to obtain drugs as directed by the supervising anesthesiologist. An anesthesiologist assistant may not prescribe, order, compound, or dispense drugs, medications, or devices of any kind.
[ 2024 c 362 s 4.]

catchline: Permitted duties to be delegated.


title: RCW 18.71D.050

text:
No anesthesiologist who supervises a licensed anesthesiologist assistant in accordance with and within the terms of any permission granted by the commission is considered as aiding and abetting an unlicensed person to practice medicine. The supervising anesthesiologist and anesthesiologist assistant shall retain professional and personal responsibility for any act which constitutes the practice of medicine as defined in RCW 18.71.011 when performed by the anesthesiologist assistant.
[ 2024 c 362 s 5.]


title: RCW 18.71D.060

text:
An anesthesiologist assistant may sign and attest to any certificates, cards, forms, or other required documentation that the anesthesiologist assistant's supervising anesthesiologist may sign, provided that it is within the anesthesiologist assistant's scope of practice.
[ 2024 c 362 s 6.]

catchline: Signing and attesting to required documentation.


title: RCW 18.71D.070

text:
(1) The uniform disciplinary act, chapter 18.130 RCW, governs the issuance and denial of licenses and the discipline of licensees under this chapter.
(2) The commission shall consult with the board of osteopathic medicine and surgery when investigating allegations of unprofessional conduct against a licensee who has a supervising anesthesiologist license under chapter 18.57 RCW.
[ 2024 c 362 s 7.]

catchline: Application of uniform disciplinary act.


title: RCW 18.73.010

text:
The legislature finds that a statewide program of emergency medical care is necessary to promote the health, safety, and welfare of the citizens of this state. The intent of the legislature is to assure minimum standards and training for first responders and emergency medical technicians, and minimum standards for ambulance services, ambulances, aid vehicles, aid services, and emergency medical equipment.
[ 1990 c 269 s 22; 1988 c 104 s 2; 1987 c 214 s 1; 1973 1st ex.s. c 208 s 1.]

catchline: Legislative finding.


title: RCW 18.73.020

text:
The legislature further declares its intention to supersede all ordinances, regulations, and requirements promulgated by counties, cities and other political subdivisions of the state of Washington, insofar as they may provide for the regulation of emergency medical care, first aid, and ambulance services which do not exceed the provisions of this chapter; except that (1) license fees established in this chapter shall supersede all license fees of counties, cities and other political subdivisions of this state; and, (2) nothing in this chapter shall alter the provisions of RCW 18.71.200, 18.71.210, and 18.71.220.
[ 1986 c 259 s 118; 1973 1st ex.s. c 208 s 2.]
Notes:
Severability—1986 c 259: See note following RCW 18.130.010.

catchline: Supersession of local regulation.


title: RCW 18.73.030

text:
The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.
(1) "Advanced life support" means invasive emergency medical services requiring advanced medical treatment skills as defined by chapter 18.71 RCW.
(2) "Aid service" means an organization that operates one or more aid vehicles.
(3) "Aid vehicle" means a vehicle used to carry aid equipment and individuals trained in first aid or emergency medical procedure.
(4) "Ambulance" means a ground or air vehicle designed and used to transport the ill and injured and to provide personnel, facilities, and equipment to treat patients before and during transportation.
(5) "Ambulance service" means an organization that operates one or more ambulances.
(6) "Basic life support" means noninvasive emergency medical services requiring basic medical treatment skills as defined in this chapter.
(7) "Collaborative medical care" means medical treatment and care provided pursuant to agreements with local, regional, or state public health agencies to control and prevent the spread of communicable diseases which is rendered separately from emergency medical service.
(8) "Communications system" means a radio and landline network which provides rapid public access, coordinated central dispatching of services, and coordination of personnel, equipment, and facilities in an emergency medical services and trauma care system.
(9) "Council" means the local or regional emergency medical services and trauma care council as authorized under chapter 70.168 RCW.
(10) "Department" means the department of health.
(11) "Emergency medical service" means medical treatment and care which may be rendered at the scene of any medical emergency or while transporting any patient in an ambulance to an appropriate medical facility, including ambulance transportation between medical facilities.
(12) "Emergency medical services medical program director" means a person who is an approved medical program director as defined by RCW 18.71.205(4).
(13) "Emergency medical technician" means a person who is authorized by the secretary to render emergency medical care pursuant to RCW 18.73.081, under the responsible supervision and direction of an approved medical program director, which may include participating in an emergency services supervisory organization or a community assistance referral and education services program established under RCW 35.21.930, or providing collaborative medical care if the participation or provision of collaborative medical care does not exceed the participant's training and certification.
(14) "Emergency services supervisory organization" means an entity that is authorized by the secretary to use certified emergency medical services personnel to provide medical evaluation or initial treatment, or both, to sick or injured people, while in the course of duties with the organization for on-site medical care prior to any necessary activation of emergency medical services. Emergency services supervisory organizations include law enforcement agencies, disaster management organizations, search and rescue operations, diversion centers, and businesses with organized industrial safety teams.
(15) "First responder" means a person who is authorized by the secretary to render emergency medical care as defined by RCW 18.73.081.
(16) "Interfacility transport" means medical transport of a patient between recognized medical treatment facilities requested by a licensed health care provider.
(17) "Organ transport service" means an organization that operates one or more organ transport vehicles.
(18) "Organ transport vehicle" has the same meaning as in RCW 46.04.371.
(19) "Patient care procedures" means written operating guidelines adopted by the regional emergency medical services and trauma care council, in consultation with the local emergency medical services and trauma care councils, emergency communication centers, and the emergency medical services medical program director, in accordance with statewide minimum standards. The patient care procedures shall identify the level of medical care personnel to be dispatched to an emergency scene, procedures for triage of patients, the level of trauma care facility to first receive the patient, and the name and location of other trauma care facilities to receive the patient should an interfacility transfer be necessary. Procedures on interfacility transfer of patients shall be consistent with the transfer procedures in chapter 70.170 RCW.
(20) "Prehospital patient care protocols" means the written procedure adopted by the emergency medical services medical program director which direct the out-of-hospital emergency care of the emergency patient which includes the trauma care patient. These procedures shall be based upon the assessment of the patient's medical needs and what treatment will be provided for emergency conditions. The protocols shall meet or exceed statewide minimum standards developed by the department in rule as authorized in chapter 70.168 RCW.
(21) "Secretary" means the secretary of the department of health.
(22) "Specialty care transport" means the level of care or service needed during an interfacility transport for a patient who is critically injured or ill and whose condition requires care by a physician, registered nurse with appropriate competencies, or a paramedic who has received special training and approval of the medical program director.
(23) "Stretcher" means a cart designed to serve as a litter for the transportation of a patient in a prone or supine position as is commonly used in the ambulance industry, such as wheeled stretchers, portable stretchers, stair chairs, solid backboards, scoop stretchers, basket stretchers, or flexible stretchers. The term does not include personal mobility aids that recline at an angle or remain at a flat position, that are owned or leased for a period of at least one week by the individual using the equipment or the individual's guardian or representative, such as wheelchairs, personal gurneys, or banana carts.
[ 2026 c 193 s 2; 2023 c 290 s 11; 2022 c 136 s 1; 2021 c 69 s 1; 2015 c 93 s 5. Prior: 2010 1st sp.s. c 7 s 25; 2005 c 193 s 2; 2000 c 93 s 16; 1990 c 269 s 23; 1988 c 104 s 3; 1987 c 214 s 2; 1983 c 112 s 5; 1979 ex.s. c 261 s 1; 1973 1st ex.s. c 208 s 3.]
Notes:
Finding—Intent—2026 c 193: "The legislature finds that a statewide program of emergency medical care is necessary to promote the health, safety, and welfare of the citizens of this state. The intent of the legislature is to assure minimum standards and training for first responders and emergency medical technicians, and minimum standards for ambulance services, ambulances, aid vehicles, aid services, and emergency medical equipment. It is further the intent of the legislature to improve timely and safe interfacility specialty care transfers of patients to the appropriate level of care when workforce limitations would otherwise inhibit the transport." [ 2026 c 193 s 1.]
Effective date—2010 1st sp.s. c 26; 2010 1st sp.s. c 7: See note following RCW 43.03.027.
Finding—2005 c 193: "The legislature finds that requiring all patients who need to travel in a prone or supine position but are medically stable, to be transported by ambulance can be overly restrictive to individuals with disabilities. These individuals frequently travel by means of reclining wheelchairs or devices commonly referred to as banana carts. Expanding travel options for these individuals will give them greater opportunities for mobility and reduce their costs of travel." [ 2005 c 193 s 1.]

catchline: Definitions.


title: RCW 18.73.081

text:
In addition to other duties prescribed by law, the secretary shall:
(1) Prescribe minimum requirements for:
(a) Ambulance, air ambulance, organ transport vehicles, and aid vehicles and equipment;
(b) Ambulance and aid services; and
(c) Minimum emergency communication equipment;
(2) Adopt procedures for services that fail to perform in accordance with minimum requirements;
(3) Prescribe minimum standards for first responder and emergency medical technician training including:
(a) Adoption of curriculum and period of certification;
(b) Procedures for provisional certification, certification, recertification, decertification, or modification of certificates;
(c) Adoption of requirements for ongoing training and evaluation, as approved by the county medical program director, to include appropriate evaluation for individual knowledge and skills. The first responder, emergency medical technician, or emergency medical services provider agency may elect a program of continuing education and a written and practical examination instead of meeting the ongoing training and evaluation requirements;
(d) Procedures for reciprocity with other states or national certifying agencies;
(e) Review and approval or disapproval of training programs; and
(f) Adoption of standards for numbers and qualifications of instructional personnel required for first responder and emergency medical technician training programs;
(4) Prescribe minimum requirements for liability insurance to be carried by licensed services except that this requirement shall not apply to public bodies; and
(5) Certify emergency medical program directors.
[ 2023 c 290 s 10; 2022 c 136 s 3; 1993 c 254 s 1; 1990 c 269 s 24; 1988 c 111 s 1; 1987 c 214 s 7.]

catchline: Duties of secretary—Minimum requirements to be prescribed.


title: RCW 18.73.101

text:
The secretary may grant a variance from a provision of this chapter and RCW 18.71.200 through 18.71.220 if no detriment to health and safety would result from the variance and compliance is expected to cause reduction or loss of existing emergency medical services. Variances may be granted for a period of no more than one year. A variance may be renewed by the secretary.
[ 2010 1st sp.s. c 7 s 26; 2000 c 93 s 17; 1987 c 214 s 9.]
Notes:
Effective date—2010 1st sp.s. c 26; 2010 1st sp.s. c 7: See note following RCW 43.03.027.

catchline: Variance from requirements.


title: RCW 18.73.120

text:
The secretary shall recognize a current certificate of advanced first aid qualification for those who provide proof of advanced Red Cross training or its equivalent.
[ 1979 ex.s. c 261 s 12; 1973 1st ex.s. c 208 s 12.]

catchline: Certificate of advanced first aid qualification.


title: RCW 18.73.130

text:
An ambulance service or aid service may not operate in the state of Washington without holding a license for such operation, issued by the secretary when such operation is consistent with the statewide and regional emergency medical services and trauma care plans established pursuant to chapter 70.168 RCW, indicating the general area to be served and the number of vehicles to be used, with the following exceptions:
(1) The United States government;
(2) Ambulance services providing service in other states when bringing patients into this state;
(3) Owners of businesses in which ambulance or aid vehicles are used exclusively on company property but occasionally in emergencies may transport patients to hospitals not on company property;
(4) Operators of vehicles pressed into service for transportation of patients in emergencies when licensed ambulances are not available or cannot meet overwhelming demand; and
(5) Emergency services supervisory organizations, as defined in *RCW 18.73.030(13). All entities that employ certified emergency medical services personnel must ensure that such personnel work under the medical oversight and protocols of a medical program director and within their scope of practice, are able to meet certification training requirements, and are provided with necessary medical equipment to provide care at their level of certification.
The license shall be valid for a period of two years and shall be renewed on request provided the holder has consistently complied with the regulations of the department and the department of licensing and provided also that the needs of the area served have been met satisfactorily. The license shall not be transferable and may be revoked if the service is found in violation of rules adopted by the department.
[ 2021 c 69 s 2; 2000 c 93 s 18; 1992 c 128 s 2; 1990 c 269 s 25; 1987 c 214 s 10; 1979 ex.s. c 261 s 13; 1979 c 158 s 61; 1973 1st ex.s. c 208 s 13.]
Notes:
*Reviser's note: RCW 18.73.030 was amended by 2022 c 136 s 1, changing subsection (13) to subsection (14).
Effective date—1973 1st ex.s. c 208: See RCW 18.73.910.

catchline: Ambulance services and aid services—Licensing.


title: RCW 18.73.140

text:
The secretary shall issue an ambulance, organ transport vehicle, or aid vehicle license for each vehicle so designated. The license shall be for a period of two years and may be reissued on expiration if the vehicle and its equipment meet requirements in force at the time of expiration of the license period. The license may be revoked if the ambulance, organ transport vehicle, or aid vehicle is found to be operating in violation of the regulations promulgated by the department or without required equipment. The license shall be terminated automatically if the vehicle is sold or transferred to the control of any organization not currently licensed as an ambulance, organ transport vehicle, or aid vehicle service. The license number shall be prominently displayed on each vehicle.
[ 2023 c 290 s 9; 2000 c 93 s 19; 1992 c 128 s 3; 1987 c 214 s 11; 1979 ex.s. c 261 s 14; 1973 1st ex.s. c 208 s 14.]
Notes:
Effective date—1973 1st ex.s. c 208: See RCW 18.73.910.

catchline: Ambulance, organ transport vehicle, and aid vehicles—Licenses.


title: RCW 18.73.145

text:
The secretary shall adopt a self-inspection program to assure compliance with minimum standards for vehicles and for medical equipment and personnel on all licensed vehicles. The self-inspection shall coincide with the vehicle licensing cycle and shall be recorded on forms provided by the department. The department may perform an on-site inspection of any licensed service or vehicles as needed.
[ 1987 c 214 s 13.]

catchline: Ambulance and aid vehicles—Self-inspection program.


title: RCW 18.73.150

text:
(1)(a) Any ambulance operated as such shall operate with sufficient personnel for adequate patient care, at least one of whom shall be an emergency medical technician under standards promulgated by the secretary. The emergency medical technician shall have responsibility for its operation and for the care of patients both before they are placed aboard the vehicle and during transit. If there are two or more emergency medical technicians operating the ambulance, a nondriving medical technician shall be in command of the vehicle. The emergency medical technician in command of the vehicle shall be in the patient compartment and in attendance to the patient.
(b) Except as provided in subsections (2) and (3) of this section, the driver of the ambulance shall have at least a certificate of advance first aid qualification recognized by the secretary pursuant to RCW 18.73.120 unless there are at least two certified emergency medical technicians in attendance of the patient, in which case the driver shall not be required to have such certificate.
(2) With approval from the department, an ambulance service established by volunteer or municipal corporations, or by an association made up entirely of two or more municipalities, in a rural area with insufficient personnel may use a driver without any medical or first aid training so long as the driver is at least eighteen years old, successfully passes a background check issued or approved by the department, possesses a valid driver's license with no restrictions, is accompanied by a nondriving emergency medical technician while operating the ambulance during a response or transport of a patient, and only provides medical care to patients to the level that they are trained.
(3)(a) A registered nurse without an emergency medical technician certification is sufficient personnel for an ambulance service providing an interfacility specialty care transport if:
(i) There is at least one emergency medical technician within the ambulance;
(ii) The registered nurse has the appropriate competencies to provide patient care during the interfacility specialty care transport;
(iii) The ambulance service providing interfacility specialty care transport does not have a paramedic on an employed or volunteer basis available to respond to the call for service; and
(iv) The sending hospital does not have a registered nurse with an emergency medical technician certification available to respond to the call for service.
(b) A registered nurse providing patient care during an interfacility specialty care transport under this subsection must follow the medical direction of the sending or receiving physician.
(c) A registered nurse participating in an interfacility specialty care transport under this subsection must work under the registered nurse scope of practice in alignment with the standards, competence, and professional accountability established by the state board of nursing.
(d) The sending hospital shall coordinate with the ambulance service to confirm that the registered nurse is familiar with the equipment and medical supplies in the ambulance before the nurse participates in an interfacility specialty care transport under this subsection.
[ 2026 c 193 s 3; 2021 c 17 s 1; 2017 c 70 s 1; 1992 c 128 s 4; 1979 ex.s. c 261 s 15; 1973 1st ex.s. c 208 s 15.]
Notes:
Finding—Intent—2026 c 193: See note following RCW 18.73.030.
Effective date—1973 1st ex.s. c 208: See RCW 18.73.910.

catchline: Ambulance personnel requirements.


title: RCW 18.73.152

text:
(1) Except as provided in subsection (2) of this section, an emergency medical technician shall become recertified every three years.
(2) An emergency medical technician who has been certified in Washington for at least 10 years shall become recertified every six years.
[ 2026 c 11 s 1.]


title: RCW 18.73.155

text:
An applicant with military training or experience satisfies the training or experience requirements of this chapter unless the secretary determines that the military training or experience is not substantially equivalent to the standards of this state.
[ 2011 c 32 s 7.]

catchline: Requirements—Military training or experience.


title: RCW 18.73.165

text:
The department shall develop a process for authorizing a student who is 16 years of age to begin an emergency medical services training course administered by a state-approved skill center or other bona fide vocational educational program approved by the office of the superintendent of public instruction, provided that the program requires continuous training until the student graduates from high school or turns 18 years of age, whichever is earlier.
[ 2025 c 98 s 2.]
Notes:
Finding—Intent—2025 c 98: "The legislature finds that school districts across the state have spent significant resources to develop and offer skill center programs and career and technical education programs for high school students. Many of these programs are designed to allow students to begin working in the field during or upon completion of the program; however, some state agencies have enacted rules that place age restrictions on when a student can start a program, test for a license or certification, or work in a profession for which they have been issued a certification or license. These restrictions are not required by federal law, are inconsistent with many other states, and are barriers to 16 and 17 year old students being able to continue with more advanced coursework or otherwise work in a profession after completing training and certification or licensure.
Therefore, the legislature intends to direct specified state agencies to revise rules or policies that have been identified as barriers to 16 and 17 year old students being able to continue with more advanced coursework or otherwise work in a profession after completing training and certification or licensure." [ 2025 c 98 s 1.]

catchline: Emergency medical services training course—Students.


title: RCW 18.73.170

text:
The aid vehicle shall be operated in accordance with standards promulgated by the secretary, by at least one person holding a certificate recognized under RCW 18.73.120.
The aid vehicle may be used for transportation of patients only when it is impossible or impractical to obtain an ambulance or when a wait for arrival of an ambulance would place the life of the patient in jeopardy. If so used, the vehicle shall be under the command of a person holding a certificate recognized pursuant to RCW 18.73.081 other than the driver.
[ 1987 c 214 s 12; 1979 ex.s. c 261 s 17; 1973 1st ex.s. c 208 s 17.]
Notes:
Effective date—1973 1st ex.s. c 208: See RCW 18.73.910.

catchline: Aid vehicles—Personnel—Use.


title: RCW 18.73.180

text:
Other vehicles not herein defined by this chapter shall not be used for transportation of patients who must be carried on a stretcher or who may require medical attention en route, except that such transportation may be used when:
(1) A disaster creates a situation that cannot be served by licensed ambulances; or
(2) The use of a stretcher is necessary because an individual's personal mobility aid cannot be adequately secured in the nonambulance vehicle and the individual has written authorization from his or her physician that it is safe to transfer the individual from a personal mobility aid to a stretcher.
[ 2007 c 305 s 1; 1987 c 214 s 14; 1979 ex.s. c 261 s 18; 1973 1st ex.s. c 208 s 18.]
Notes:
Effective date—1973 1st ex.s. c 208: See RCW 18.73.910.

catchline: Other transportation vehicles.


title: RCW 18.73.190

text:
Any person who violates any of the provisions of this chapter and for which a penalty is not provided shall be deemed guilty of a misdemeanor and upon conviction thereof, shall be fined in any sum not exceeding one hundred dollars for each day of the violation, or may be imprisoned in the county jail not exceeding six months.
[ 1987 c 214 s 15; 1973 1st ex.s. c 208 s 19.]
Notes:
Effective date—1973 1st ex.s. c 208: See RCW 18.73.910.

catchline: Violations—Penalties.


title: RCW 18.73.200

text:
The administrative procedure act, chapter 34.05 RCW, shall wherever applicable govern the rights, remedies, and procedures respecting the administration of this chapter.
[ 1973 1st ex.s. c 208 s 21.]

catchline: Administrative procedure act applicable.


title: RCW 18.73.240

text:
The uniform disciplinary act, chapter 18.130 RCW, shall govern the issuance and denial of credentials, unauthorized practice, and the discipline of persons credentialed under this chapter. The secretary shall act as the disciplinary authority under this chapter. Disciplinary action shall be initiated against a person credentialed under this chapter in a manner consistent with the responsibilities and duties of the medical program director under whom such person is responsible.
[ 1992 c 128 s 5.]

catchline: Application of uniform disciplinary act.


title: RCW 18.73.250

text:
(1) All of the state's ambulance and aid services shall make epinephrine available to their emergency medical technicians in their emergency care supplies. The emergency medical technician may administer epinephrine.
(2) Nothing in this section authorizes the administration of epinephrine by a first responder.
[ 2005 c 463 s 1; 2001 c 24 s 1; 1999 c 337 s 4.]
Notes:
Findings—Purpose—1999 c 337: "The legislature finds that allergies are a serious medical disorder that affect more than one in five persons in the United States and are the sixth leading cause of chronic disease. Anaphylaxis is the most severe form of allergic reaction. Rapid and appropriate administration of the drug epinephrine to a patient suffering an anaphylaxis allergic reaction may make the difference between the life and death of that patient. The legislature further finds that some situations may arise when the administration of epinephrine by an emergency medical technician is required to save a person's life and that it is paramount that these valuable emergency response personnel receive the appropriate training on the use of epinephrine to treat anaphylaxis.
It is the purpose of chapter 337, Laws of 1999 to investigate the rate of anaphylaxis statewide and the training and care standards needed to allow emergency medical technicians to administer lifesaving epinephrine." [ 1999 c 337 s 1.]
Effective dates—1999 c 337: "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 [May 14, 1999], except for section 4 of this act which takes effect January 1, 2000." [ 1999 c 337 s 5.]
Short title—1999 c 337: "This act may be known and cited as the Kristine Kastner Act." [ 1999 c 337 s 6.]


title: RCW 18.73.260

text:
(1) The department of health shall convene a stakeholder group including the department of social and health services, the department of transportation, and local special needs transportation providers who shall assist in the development of guidelines for the safe transport of individuals who rely on stretchers and personal mobility devices.
(2) The department of health shall prepare guidelines for the public and vehicle operators relating to:
(a) Appropriate situations in which vehicles other than ambulances may be used to transport individuals who rely upon personal mobility aids in the normal course of their lives; and
(b) Methods for properly securing personal mobility aids on vehicles other than ambulances and determining if they are adequately secured.
[ 2007 c 305 s 2.]

catchline: Guidelines.


title: RCW 18.73.270

text:
(1) Except when treatment is provided in a hospital licensed under chapter 70.41 RCW, a physician's trained advanced emergency medical technician and paramedic, emergency medical technician, or first responder who renders treatment to a patient for (a) a bullet wound, gunshot wound, powder burn, or other injury arising from or caused by the discharge of a firearm; (b) an injury caused by a knife, an ice pick, or any other sharp or pointed instrument which federal, state, or local law enforcement authorities reasonably believe to have been intentionally inflicted upon a person; (c) a blunt force injury that federal, state, or local law enforcement authorities reasonably believe resulted from a criminal act; or (d) injuries sustained in an automobile collision, shall disclose without the patient's authorization, upon a request from a federal, state, or local law enforcement authority as defined in RCW 70.02.010, the following information, if known:
(i) The name of the patient;
(ii) The patient's residence;
(iii) The patient's sex;
(iv) The patient's age;
(v) The patient's condition or extent and location of injuries as determined by the physician's trained advanced emergency medical technician and paramedic, emergency medical technician, or first responder;
(vi) Whether the patient was conscious when contacted;
(vii) Whether the patient appears to have consumed alcohol or appears to be under the influence of alcohol or drugs;
(viii) The name or names of the physician's trained advanced emergency medical technician and paramedic, emergency medical technician, or first responder who provided treatment to the patient; and
(ix) The name of the facility to which the patient is being transported for additional treatment.
(2) A physician's trained advanced emergency medical technician and paramedic, emergency medical technician, first responder, or other individual who discloses information pursuant to this section is immune from civil or criminal liability or professional licensure action for the disclosure, provided that the physician's trained advanced emergency medical technician and paramedic, emergency medical technician, first responder, or other individual acted in good faith and without gross negligence or willful or wanton misconduct.
(3) The obligation to provide information pursuant to this section is secondary to patient care needs. Information must be provided as soon as reasonably possible taking into consideration a patient's emergency care needs.
(4) For purposes of this section, "a physician's trained advanced emergency medical technician and paramedic" has the same meaning as in RCW 18.71.200.
[ 2025 c 58 s 2007; 2009 c 359 s 1.]
Notes:
Explanatory note—2025 c 58: See note following RCW 1.16.050.

catchline: Disclosure of information by emergency medical personnel—Violent injuries—Immunity.


title: RCW 18.73.280

text:
An ambulance service may transport patients to a nonmedical facility, such as a mental health facility or chemical dependency program as authorized in regional emergency medical services and trauma care plans under RCW 70.168.100.
[ 2015 c 157 s 4.]

catchline: Ambulance service—Transport of patients to a nonmedical facility.


title: RCW 18.73.290

text:
(1) An organ transport service may not operate in the state of Washington without holding a license for such operation, issued by the secretary in consultation with the department of licensing.
(2) Organ transport services must ensure that personnel operating organ transport vehicles:
(a) Are at least 25 years of age;
(b) Are a current, previous, or retired police officer, firefighter, or EMS provider;
(c) Have a minimum of five years' experience operating a police, fire department, or emergency medical service vehicle under emergency conditions;
(d) Have passed a preemployment driver's license check showing no more than one moving vehicle violation in a rolling three-year period, with annual license reviews thereafter;
(e) Have passed a preemployment drug screen, with random drug screenings thereafter;
(f) Have passed state and national criminal background checks; and
(g) Have completed an emergency vehicle operators course and a defensive drivers course.
(3) An organ transport service shall maintain:
(a) Commercial general liability insurance in the amount of $5,000,000/$10,000,000 aggregate;
(b) Automobile liability insurance in the amount of $5,000,000; and
(c) An umbrella policy in the amount of $2,000,000.
(4) The license shall be valid for a period of two years and shall be renewed on request provided the holder has consistently complied with the regulations of the department and the department of licensing and provided also that the needs of the area served have been met satisfactorily. The license shall not be transferable and may be revoked if the service is found in violation of rules adopted by the department.
(5) The department, in consultation with the department of licensing, shall adopt rules under chapter 34.05 RCW to implement this section.
(6) Employment as a driver for organ transport vehicles does not add to the scope of practice for a current EMS provider and is not considered employment as an EMS provider.
(7) The secretary shall not establish fees for the license and renewals for an organ transport service or vehicle.
[ 2023 c 290 s 12.]

catchline: Organ transport services.