Department of Health Sanctions Schedule

Health providers always want to know what sanctions they can expect when the Department of Health brings a Statement of Charges against them, or when negotiating a Stipulation to Informal Disposition [“STID”] short of formal discipline. If you are unfamiliar with the sanctions schedules, WAC 246-16-810 through WAC 246-16-860 is a good place to start.There you will find sanctions schedules applicable to practice below the standard of care, sexual misconduct or contact, abuse (physical and emotional), diversion of controlled substances or legend drugs, substance abuse, and criminal convictions. Each of the schedules have Tiers A-C based on the respective severity of the conduct alleged, with A being the least and C being the greatest. For each Tier there is a minimum and maximum range of sanctions possible, depending on any aggravating and mitigating circumstances, accompanied by a range in duration.The disciplining authority will select sanctions to protect the public first, and if possible, then also to rehabilitate the license holder—at least this is the stated purpose. The disciplining authority may deviate from the sanctions schedules if the schedule does not adequately address the facts in a given case, which may include statutory unprofessional conduct that is reciprocal based on action in another jurisdiction. However, to do so the disciplining authority will have to acknowledge the deviation and its basis.Otherwise, the disciplining authority is hemmed into a formulaic table, depending on the type of conduct, in which it starts at the midpoint of the sanctions. Then, the license holder must bring forward as much information about mitigation or lack of aggravating circumstances to argue for the minimum sanctions.Factors to consider regard the unprofessional conduct itself, i.e., the age or vulnerability of a patient, gravity of the conduct, potential for injury and any injury in-fact caused, motivation, number or frequency, and whether the conduct was intentional or inadvertent. Other factors regard the license holder, such as his/her experience in practice, past discipline, personal circumstances or problems that had any nexus with the conduct, and previous character. Factors regarding the disciplinary process may be useful, such as whether the license holder admitted key facts, took remedial action on their own volition, cooperated with the investigation, expressed remorse for wrongful conduct, and made full and free disclosure to the disciplining authority (i.e., self-reported). Other, more general factors may also be considered.It is not just the conduct itself that the disciplining authority will consider, but if/how the license holder falls on his or her sword. It is a human reaction to want to downplay facts that do not put one in a good light or to avoid embarrassment or shame, but to do so in a discipline matter as a health provider may very well ensure that the higher range of sanctions will be applied or that you will have less leverage to enter into a STID. Thus, even if you have just received notice of an investigation, you may want to consult with counsel to make sure you do not run afoul of any factors relating to the disciplinary process and to gain perspective outside of your personal feelings and reactions.WAC 246-16-810 through WAC 246-16-860WAC 246-16-800WAC 246-16-890