Wash. Rev. Code § 70.230.080

Coordinated quality improvement — Rules

All ambulatory surgical facilities must implement a “coordinated quality improvement program” that contains, at minimum, the following components:

•         A quality improvement committee. The committee will conduct retrospective and prospective service review and “coordinate the quality improvement and medical malpractice prevention program.”
•         A procedure for sanctioning medical staff privileges. The procedure must involve a review of an individual’s physical and mental capacity and competence to provide health care services.
•         A procedure for resolving patient grievances regarding incidents that could lead to malpractice actions.
•         A system to collect and maintain information regarding “negative health care outcomes and incidents injurious to patients, patient grievances, professional liability premiums, settlements, awards, costs incurred by the ambulatory surgical facility for patient injury prevention, and safety improvement activities.”
•         A system to maintain information regarding individual practitioners.
•         Educational programs. These programs must address “quality improvement, patient safety, medication errors, injury prevention, staff responsibility to report professional misconduct, the legal aspects of patient care, improved communication with patients, and causes of malpractice claims for staff personnel engaged in patient care activities.”
•         Compliance policies.

Individuals that provide information to or participate on the quality improvement committee are immune from any liability that may result from their sharing of information so long as the sharing occurred in good faith. Individuals and entities that participate in a coordinated quality improvement program and share information with another quality improvement program, committee, or board are also immune from liability so long as they shared the information in good faith.

All information obtained and created by a quality improvement committee is not subject to discovery and is barred from submission into evidence in any civil action. Individuals that participate on a quality improvement committee or participate in the creation or collection of information for such a committee may not testify about the information. However, Washington does permit: (1) the discovery of the identity of individuals involved in the claim so long as their involvement is independent of quality improvement activities; (2) the testimony of an individual regarding the facts that gave rise to a committee proceeding so long as the individual obtained their knowledge independent of the proceeding; (3) introduction of evidence collected by a quality improvement committee regarding the restriction or revocation of a provider’s clinical or staff privileges; (4) the disclosure that an individual’s staff privileges “were terminated or restricted, including the specific restrictions imposed, if any, and the reasons for the restrictions;” and (5) “discovery and introduction into evidence of the patient's medical records required by rule of the department to be made regarding the care and treatment received.”

All quality improvement committees must provide an annual report to their ambulatory surgical facility’s management regarding the committee’s activities and actions.

When a quality improvement committee restricts or terminates a practitioner’s privileges, the relevant “medical quality assurance commission, the board of osteopathic medicine and surgery, or the podiatric medical board” may review the committee’s records regarding the termination or restriction. Such information is confidential and not subject to discovery. Ambulatory surgical facilities that do not allow the relevant commission or board to access the committee records may be punished with a maximum fine of $250.

Ambulatory care facilities must make quality improvement committee records and peer review records available to the department of health or accrediting organization pursuant to the inspection and review of the facility. Information obtained pursuant to such inspection and review is confidential and not subject to discovery.

A coordinated quality improvement program may share information with other quality improvement programs, quality assurance committees, or peer review committees for the purpose of improving health care quality and preventing malpractice. Such programs must share the information in compliance with HIPAA and other laws regarding the privacy and confidentiality of health information. Any information shared pursuant to this section is not subject to discovery.

Violations of this section do not constitute negligence per se.