Medication access and midwifery integration: An example of community midwifery advocacy for access in Washington State, USA
2020; Wiley; Volume: 48; Issue: 1 Linguagem: Inglês
10.1111/birt.12523
ISSN1523-536X
AutoresKristin J. Effland, Karen Hays, Britney A. Zell, Tara K. Lawal, Megan Koontz,
Tópico(s)Child and Adolescent Health
ResumoBirthVolume 48, Issue 1 p. 4-13 COMMENTARYFree Access Medication access and midwifery integration: An example of community midwifery advocacy for access in Washington State, USA Kristin J. Effland CPM, LM, MA, Corresponding Author Kristin J. Effland CPM, LM, MA [email protected] [email protected] orcid.org/0000-0003-3113-9745 Department of Midwifery, Bastyr University, Kenmore, WA, USA Midwives College of Utah, Salt Lake City, UT, USA Correspondence Kristin J. Effland, CPM, LM, MA, Department of Midwifery, Bastyr University, 8650 Icicle Rd Leavenworth, WA 98826, USA. Email: [email protected]; [email protected]Search for more papers by this authorKaren E. Hays CNM, DNP, ARNP, Karen E. Hays CNM, DNP, ARNP Department of Midwifery, Bastyr University, Kenmore, WA, USASearch for more papers by this authorBritney A. Zell BS, SM, Britney A. Zell BS, SM Department of Midwifery, Bastyr University, Kenmore, WA, USASearch for more papers by this authorTara K. Lawal MS, RN, DNP Candidate, Tara K. Lawal MS, RN, DNP Candidate Rainier Valley Midwives, Seattle, WA, USASearch for more papers by this authorMegan Koontz CPM, MM, Megan Koontz CPM, MM Midwives College of Utah, Salt Lake City, UT, USA NACPM, Williston, VT, USASearch for more papers by this author Kristin J. Effland CPM, LM, MA, Corresponding Author Kristin J. Effland CPM, LM, MA [email protected] [email protected] orcid.org/0000-0003-3113-9745 Department of Midwifery, Bastyr University, Kenmore, WA, USA Midwives College of Utah, Salt Lake City, UT, USA Correspondence Kristin J. Effland, CPM, LM, MA, Department of Midwifery, Bastyr University, 8650 Icicle Rd Leavenworth, WA 98826, USA. Email: [email protected]; [email protected]Search for more papers by this authorKaren E. Hays CNM, DNP, ARNP, Karen E. Hays CNM, DNP, ARNP Department of Midwifery, Bastyr University, Kenmore, WA, USASearch for more papers by this authorBritney A. Zell BS, SM, Britney A. Zell BS, SM Department of Midwifery, Bastyr University, Kenmore, WA, USASearch for more papers by this authorTara K. Lawal MS, RN, DNP Candidate, Tara K. Lawal MS, RN, DNP Candidate Rainier Valley Midwives, Seattle, WA, USASearch for more papers by this authorMegan Koontz CPM, MM, Megan Koontz CPM, MM Midwives College of Utah, Salt Lake City, UT, USA NACPM, Williston, VT, USASearch for more papers by this author First published: 14 December 2020 https://doi.org/10.1111/birt.12523Citations: 1AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Families who choose midwives for prenatal and postpartum care and plan births at home or in freestanding birth centers deserve access to essential resources. However, the majority of United States community-based practitioners are direct-entry midwives, whose practice is restricted by local licensing and regulation statutes (detailed in Table 1).1 In addition, the regulation is made more complicated by multiple certification options (certified professional midwife (CPM), certified nurse-midwife (CNM), and certified midwife (CM); Table 2). Despite the heterogeneity in practice settings and educational pathways, the ability to use all appropriate medications and devices enhances a midwife's ability to prevent or manage first-line complications and assists in identifying and referring clients who require obstetric or pediatric attention.2 It follows that a lack of access to the medications and equipment required for the care of low-risk childbearing persons affects client autonomy and choice, especially in perinatal health professional shortage areas.2 Advocating for increased midwifery access to the medications and devices that enhance the care of healthy, low-risk pregnant and postpartum persons is a priority in the United States.2, 3 TABLE 1. Community midwife drug legend by US state/territory for direct-entry midwives©4, a State/ Territory Title Interconception Careb Oxytocin/Pitocin (postpartum) Eye prophylaxis Local anesthetics Oxygen Vitamin K RhIG Other antihemorrhagics IV fluids GBS antibiotics Epinephrine for anaphylaxis Diaphragm/cervical cap Terbutaline HBV - newborn TDaP Flu vaccine MMR vaccine Other with rx Other Statute/rule changes?c Relevant statutes Relevant regulations Alabama LM X X X X R AL Code § 34-19-14 AAC 582-X-3-0.09 Alaska CDM X X X X X X X X X R AS § 08.65.030 12 AAC 14.570 Arizona LM P X P P P P R ARS § 36-755 AAC R9-16-108, 113, R9-6-338 Arkansas LLM P P P P P R ACA § 17-85-107 AAC 007.13.92-300 California LM X X X X X X X X X X X X Statutory language is vague; table represents what is used in practice. N CA BPC § 2507 16 CCR 1379.19 Colorado RM X X X X X X X X S CRS § 12-225-107 4 CCR 739-1.17, 1.18 Delaware CPM X X X X X X X X X X R DE Code § 1799HH 24 DAC 1795-4.4 DC CPM X X X X X X X X X X X X X X DC Bill 23-0202, passed; not yet enacted. R DC Code § 3-1201.02 In development Florida LM P P P P P P P X R FL Stat. § 467.005 FAC 64B24-7.011 Hawaii LM X X X X X X X X X X X Senate Bill 1033 passed; not enacted. S HRS § Ch.(to be designated)-11 Idaho LM X X X X X X X X X X R ID Stat. § 54-5505 IDAPA 24.26.01-351 Indiana CDEM X P X X P P X X CDEMs are not permitted to place IVs, so are unable to administer the antibiotics in their legend. S IC § 25-23.4-4-5 Kentucky LCPM X X X X X X X X X X X Neonatal oral glucose gel R KRS § 314.404 201 KAR 20:650-3 Louisiana LM X X X X X X X X X X Newborn epinephrine R LRS 37 § 3244 LAC 46:XLV.5325, 5349 Maine LM X X X X X New regulations in development. R 32 MRSA §13 811 In development Maryland CPM X X X X X X X X X X X R MD HO § 8-6C-12 COMAR 10.64.07 Michigan LM P P P P P P P P P P May administer ondansetron and ranitidine for nausea during labor. S MCL 368-1978-15- 17 111, 17 112 MAR 338.17137 Minnesota LTM X X X X X X X X P X X Methergine, IV fluids, GBS antibiotics, and others by prescription are not included in law, but are considered to be community standard based on guidelines from state professional organizations. S MN Stat. § 147D.09 Missouri n/a Community midwives are not licensed in Missouri but may legally practice if they have an accredited "tocological certification." Medications are not addressed in the statute. MRS § 376.1753 Montana LM/ LDEM P P P P S MCA § 37-27-302 New Hampshire CM X X X X X X X X P X S NH RSA § 326-D:12 NH Rule Mid 502 New Jersey LM X X X X X List of additional medications developed by each LM and their consulting physician, generally including those listed here other than vaccines and contraceptives. R NJSA § 45:10-22 NJAC 13:35-2A.5, 6 New Mexico LM X X X X X X X X X X X P X X X X Newborn HBIG N NM Stat. 24-1-3 16 NMAC 11.3 Oklahoma LM X X Regulations (in development) will include a formulary. R OK Stat. § 59-3040 In development Oregon LDM X X X X X X X X X X R ORS § 687.493 OAR 332-026 Rhode Island LM X X X X X X X X X X X R 216-RICR-40-05-23.10 South Carolina LM P P X P P R SCDHEC 61-24G, I South Dakota CPM X X X X X X X X X S SDLRC § 36-9C-13 SD Rule 20:86:03:11 Tennessee CPM P X X X X X P X N TCA § 63-29-107 TN R&R 1050-05-0.02 Texas LM X X X S TX Occ. Code § 203.401 16 TAC 115.118, 119 Utah LDEM X X X X X X X X X May prescribe vitamins. Licensure is optional; unlicensed midwives may administer oxygen only. S UT Code § 58-77-102 Vermont LM X X X X X X X X X X X X X X X X May also administer TDaP vaccine to partner and provide antibiotic all-purpose nipple ointment. N VSA § 26.1485 VT Admin. Rules for Midwives 3.16 Virginia LM Forbidden from carrying prescription medications. -- VA Code § 54.1-2957.9 18 VAC 85-130 Washington LM X X X X X X X X X X X X X X X X X May also obtain and administer: magnesium sulfate, nitrous oxide, newborn HBIG and epinephrine, other recommended vaccines; may prescribe: glucometers, iron supplements, prenatal vitamins, vaccines R RCW § 18.50.115 WAC 246-834-250 Wisconsin LM P P P P P P P X R WI Stat. § 440.984 WI Admin. Code SPS 182.03 Wyoming LM X X X X X X X X X X X R WY Stat. § 33-46-103 WY Code 036.0001.10 TOTAL 34 7 31 31 30 30 29 28 27 22 21 17 6 4 4 3 3 2 12 Note ©Copyright 20204 (https://midwifemedications.weebly.com/). This table reflects statutory and regulatory language, but community standards in each locale may vary. P = only by prescription or standing order by a practitioner with ability to prescribe said medication Abbreviations: LM, licensed midwife; CDM/CDEM, certified direct-entry midwife; LLM, licensed lay midwife; RM, registered midwife; CPM, certified professional midwife; LTM, licensed traditional midwife; LDEM/LDM, licensed direct-entry midwife; CM, certified midwife; NH-specific title; not affiliated with AMCB CMs; LCPM, licensed certified professional midwife. a States/territories not listed here do not currently offer licensure to direct-entry midwives. This table only applies to CMs when they have the same scope of practice as non–AMCB-certified direct-entry midwives. b Legislative changes would usually be required to alter the definition of midwifery in order to allow interconception care. c S = changes to statute needed to alter formulary, R = changes to regulation needed only, N = no law changes needed TABLE 2. United States National Midwifery Credentials Certified professional midwife (CPM) Certified nurse-midwife (CNM) Certified midwife (CM) Legal status Licensure available in 35 states Licensure available in all 50 states, American Samoa, Guam, Puerto Rico, the United States Virgin Islands Licensure available in seven states Prescriptive authority None or minimal, but may access and administer medications (see Table 1) Prescriptive authority in all states and territories, although scope varies New York, Rhode Island, and Maine only Practice setting Primarily community settings (birth centers, homes, and clinics), although a small proportion of CPMs have gained privileges in hospitals or worked at Federally Qualified Health Centers Hospitals and community settings, although most CNMs and CMs attend births in hospitals Client population Often limited to pregnant, birthing, and postpartum individuals and newborns, although occasionally including the preconception or interconception periods Pregnant, birthing, and postpartum individuals; newborns; and people seeking gynecology, preconception, contraception, or limited primary care services Practice authority Based on state or territorial laws and regulations, ranges from practicing independently to requiring written practice agreements or physician supervision. Professional association National Association of Certified Professional Midwives (NACPM) American College of Nurse-Midwives (ACNM) Midwives Alliance of North America (MANA) is a non–credential-specific professional association Certifying Body North American Registry of Midwives (NARM)—accredited by the National Commission for Certifying Agencies (NCCA) American Midwifery Certification Board (AMCB)—accredited by the National Commission for Certifying Agencies (NCCA) Educational route Direct entry (no prior nursing degree necessary) Nursing followed by midwifery Direct entry (no prior nursing degree necessary) Educational requirements for certification Graduation from a MEAC (Midwifery Education Accreditation Council)-accredited program or institution OR completion of the Portfolio Evaluation Process for nonaccredited educational pathways overseen by NARM Licensure as a registered nurse AND graduation from an ACME (Accreditation Commission for Midwifery Education)-accredited graduate program Graduation from an ACME-accredited graduate program Length of midwifery education 2-4 yr RN education +2 yr Previous bachelor's degree +2 yr For more details on these credentials, including requirements for certification, see the 2017 table comparing CPMs, CNMs, and CMs at https://www.midwife.org/acnm/files/ccLibraryFiles/FILENAME/000000006807/FINAL-ComparisonChart-Oct2017.pdf Organizations from the local to international levels are calling for an expansion of evidence-based, comprehensive, and integrated midwifery care.5-9 The International Confederation of Midwives (ICM) represents midwives across the globe and recognizes that well-crafted regulatory frameworks “lead to an increased number of competent midwives in their countries practicing the full scope of midwifery.”10 Limited access to medications and devices acts as a barrier to the successful integration of midwifery within the United States health care system.6, 7, 9, 11 Access to essential medicines, an aspect of practice authority, is one factor assessed by Vedam and colleagues, who measured midwifery integration within state health care systems. These researchers concluded that higher state-level integration scores were consistently associated with improved perinatal outcomes.11 A profession's practice authority is related to the practitioners’ ability to practice across the full scope of their education and credentialing.12 Increased practice authority for midwives and advanced practice nurses improves use of services and affects the size and demographics of the workforce without negatively impacting quality of care, thereby expanding client choice of practitioner and increasing access to care, particularly in medically underserved rural and urban areas.12-18 The World Health Organization (WHO) publishes a model list of “essential medicines,”19 including the ideal formulary for health care practitioners who provide pregnancy, childbirth, postpartum, and newborn care along with family planning services. Many of the WHO recommendations for a first-level health facility apply to the independent clinics, freestanding birth centers, and client homes where community-based midwives practice in the United States.20, 21 Midwives and policymakers have an obligation to consider the ethical aspects of this topic.22 Lack of access to essential medications and devices inhibits the ability of midwives to do good (beneficence) and also inhibits a midwife's ability to do no harm despite adequate training (nonmaleficence). Lack of access to a fully equipped care practitioner also restricts client choice (autonomy). Furthermore, because access is restricted, not because of midwives’ capabilities, but because of the influence of uninformed or oppositional stakeholders in the system with more power, the ethical principle of justice also applies. Internationally, multiple countries that regulate direct-entry midwives provide flexible access to medications and devices relevant to the ever-changing recommendations for the care of low-risk childbearing people. Midwifery regulation in Sweden, the United Kingdom, Canada, Ireland, New Zealand, and Australia exemplifies this approach.23 Globally, midwives specialize in a holistic and wellness-based model of health care that is enhanced by the ability to use medications or devices including those required for the rarely needed but necessary management of emerging complications.24 The health care system in New Zealand (NZ), for example, has benefitted from licensing direct-entry midwives, relieving pressure on primary care practitioners, rural health care practitioners, and professionals serving traditionally underserved communities. According to the Australian and New Zealand Council of Chief Nursing and Midwifery Officers, “one way of addressing the issues associated with access to health care is to expand the scope of practice of health practitioners … and enable them to work to their full scope of practice (p. 1).”23 In 1990, NZ did just that when they extended the Medicines Act to ensure that their people would have ready access to all essential and relevant medications when receiving care from a direct-entry midwife. Increased autonomy for midwives in NZ has not resolved all of the structural inequalities within the health care system, but families throughout the country now have more access to high-quality perinatal health care. Inequities in access to care in NZ resulted in an increased scope for midwives on a national level. In contrast, most US states have laws that restrict midwives’ ability to carry, obtain, purchase, dispense, administer, or use certain medications, including lifesaving medications and those recommended for routine care.2 Advocacy at the local or national level offers an opportunity to improve families’ perinatal and postpartum care experiences by influencing key decision-makers to revise the regulations that currently limit the use of medications and devices in community midwifery practice. Licensed midwives (LMs) in Washington (WA) have access to more medications, devices, and supplies relevant to the care of low-risk clients than do most community midwives practicing in other United States jurisdictions (see Table 1). This level of access was made possible because of influential changes in statute that the Midwives’ Association of Washington State (MAWS) advocated for in 1987. These allowed for the subsequent ability to adjust administrative rules related to the medications and devices LMs could obtain and administer.25 Although the previous statute did allow licensed midwives to administer “other drugs or medications as prescribed by a physician,”26 this provision by itself was insufficient to ensure that families had timely access to routine and lifesaving medications. Some midwives had no supportive collaborative physician relationships, and others who did knew that those relationships were fragile. In rural areas, obstetricians were often unavailable as a result of relocation or retirement. There were also structural barriers to collaboration within health care systems, some of which remain unresolved, because community-based midwifery in WA functions independently from the hospitals who receive transfers of care. In Washington state, further amendments to the statute will likely be needed before childbearing families who choose community midwives will have access to more contraception options, for example.26 The professional association (MAWS), though, is well positioned to embrace this advocacy project because of their regular presence at the state capitol over the last 30 years, through visibility during annual lobby days and through their paid lobbyist. Midwives in WA have built relationships with their legislators and become comfortable making requests for support. Introducing legislation to update the statute is the next step as the association seeks to close the statutory gaps that prevent low-risk clients from receiving the full scope of care from their community midwife, especially in rural and urban underserved areas. As midwifery advocates in their own jurisdictions consider their goals and plans for increasing access to essential medications and devices, the role of community participation from diverse stakeholders (especially from those commonly left unheard) is critical. Well-advertised public meetings at times and places convenient to community members offer one forum for information gathering and consumer organizing. In addition, in order to increase access and representation and to acknowledge persistent systemic inequities, free membership to the association can be offered for midwives and student midwives of color if they reside or work in the state. Community midwives and service users in WA have broken down barriers to access and facilitated further integration of midwifery into the health care system through persistence and advocacy. What began in WA as very limited access to only three medications four decades ago has been expanded to include a more comprehensive formulary of medications and devices than in many other United States jurisdictions. Families who choose midwives for their care, especially those living in underserved rural and urban shortage areas, benefit from this increased access and autonomy. Access to medications and devices is governed by local rather than national regulations in the United States. As such, midwifery advocates in other jurisdictions who wish to expand access for families also have to act locally. We offer the Washington state example in the hopes that all communities in the United States and beyond can have access to a full range of maternity care options, including midwife-led, community-based care. ACKNOWLEDGMENTS Much appreciation is due to Neva Gerke, MS, LM, CPM, former MAWS president, and Constance Frey, LM, former Midwifery Advisory Committee Chair, for their primary role in securing the 2019 updates to the WA Legend Drugs and Devices. Thank you also to Jo Anne Myers-Ciecko, MPH Suzy Myers, MPH, CPM-Retired, and Audrey Levine, LM, CPM-Retired, for your insights, contributions, and guidance all these years. And much gratitude goes to all of the midwives practicing in the US states and DC who responded to help verify the content of Table 1. CONFLICT OF INTEREST The authors have no conflicts of interest to disclose. REFERENCES 1Cheyney M, Olsen C, Bovbjerg M, Everson C, Darragh I, Potter B. Practitioner and practice characteristics of certified professional midwives in the United States: Results of the 2011 North American Registry of Midwives Survey. J Midwifery Womens Health. 2015; 60(5): 534- 545. https://doi.org/10.1111/jmwh.12367 2Scrimshaw S, Backes EP. Birth Settings in America: Outcomes, Quality, Access and Choice. Washington, DC: National Academies of Sciences, Engineering and Medicine; 2020. https://doi.org/10.17226/25636 3 International Confederation of Midwives. Position Statement: The Midwife is the First Choice Health Professional For Childbearing Women. https://www.internationalmidwives.org/assets/files/statement-files/2019/07/the-midwife-is-the-first-choice-eng-1-july.pdf. Published 2014. Accessed March 29, 2020. 4 Community midwife medication access by state/territory. https://midwifemedications.weebly.com/ Published 2020. Accessed November 14, 2020. 5 Center for Reproductive Rights. Black Mamas Matter: A Toolkit for Advancing the Human Right to Safe and Respectful Maternal Health Care. https://www.reproductiverights.org/sites/default/files/documents/USPA_BMMA_Toolkit_Booklet-Final-Update_Web-Pages.pdf. Published 2018. Accessed March 29, 2020. 6Kennedy HP, Myers-Ciecko JA, Carr KC, et al. United States model midwifery legislation and regulation: Development of a consensus document. J Midwifery Womens Health. 2018; 63(6): 652- 659. https://doi.org/10.1111/jmwh.12727 7Nove A, Moyo NT, Bokosi M, Garg S. The midwifery services framework: The process of implementation. Midwifery. 2018; 58: 96- 101. https://doi.org/10.1016/j.midw.2017.12.013 8Oparah JC, Arega H, Hudson D, Jones L, Oseguera T. Battling Over Birth: Black Women and the Maternal Healthcare Crisis in California. Black Women Birthing Justice. https://www.blackwomenbirthingjustice.org/battling-over-birth. Published 2016. Accessed March 29, 2020. 9Osborne K. Regulation of prescriptive authority for certified nurse-midwives and certified midwives: 2015 national overview. J Midwifery Womens Health. 2015; 60(5): 519- 533. https://doi.org/10.1111/jmwh.12368 10 International Confederation of Midwives. Position Statement: The Midwife is the First Choice Health Professional for Childbearing Women. https://www.internationalmidwives.org/assets/files/statement-files/2019/07/the-midwife-is-the-first-choice-eng-1-july.pdf. Published 2014. Accessed March 29, 2020. 11Vedam S, Stoll K, MacDorman M, et al. Mapping integration of midwives across the United States: Impact on access, equity, and outcomes. PLoS One. 2018; 13(2):e0192523. https://doi.org/10.1371/journal.pone.0192523 12Beal MW, Batzli ME, Hoyt A. Regulation of certified nurse-midwife scope of practice: Change in the professional practice index, 2000 to 2015. J Midwifery Womens Health. 2015; 60(5): 510- 518. https://doi.org/10.1111/jmwh.12362 13Kuo YF, Loresto FL Jr, Rounds LR, Goodwin JS. States with the least restrictive regulations experienced the largest increase in patients seen by nurse practitioners. Health Aff. 2013; 32(7): 1236- 1243. https://doi.org/10.1377/hlthaff.2013.0072 14Markowitz S, Adams EK, Lewitt MJ, Dunlop AL. Competitive effects of scope of practice restrictions: Public health or public harm? J Health Econ. 2017; 55: 201- 218. https://doi.org/10.1016/j.jhealeco.2017.07.004 15Neff DF, Yoon SH, Steiner RL, et al. The impact of nurse practitioner regulations on population access to care. Nurs Outlook. 2018; 66(4): 379- 385. https://doi.org/10.1016/j.outlook.2018.03.001 16Perry JJ. State-granted practice authority: Do nurse practitioners vote with their feet? Nurs Res Pract. 2012; 2012: 482178. https://doi.org/10.1155/2012/482178 17Ranchoff BL, Declercq ER. The scope of midwifery practice regulations and the availability of the certified nurse-midwifery and certified midwifery workforce, 2012–2016. J Midwifery Womens Health. 2020; 65(1): 119- 130. 18Yang YT, Attanasio LB, Kozhimannil KB. State scope of practice laws, nurse-midwifery workforce, and childbirth procedures and outcomes. Womens Health Issues. 2016; 26(3): 262- 267. https://doi.org/10.1016/j.whi.2016.02.003 19 World Health Organization. Model list of Essential Medicines. https://apps.who.int/iris/bitstream/handle/10665/325771/WHO-MVP-EMP-IAU-2019.06-eng.pdf?ua=1. Published 2019. Accessed March 29, 2020. 20Menard MK, Kilpatrick S, Saade G, et al. Levels of maternal care. Am J Obstet Gynecol. 2015; 212(3): 259- 271. https://doi.org/10.1016/j.ajog.2014.12.030 21 World Health Organization. Packages of Interventions for Family Planning, Safe Abortion Care, Maternal, Newborn and Child Health. https://apps.who.int/iris/handle/10665/70428. Published 2010. Accessed March 29, 2020. 22Beauchamp TL, Principlism RO. Encyclopedia of Global Ethics. Cham, Switzerland: Springer; 2015. https://doi.org/10.1007/978-3-319-09483-0_348 23 Australian and New Zealand Council of Chief Nursing and Midwifery Officers. Position Statement: Registered Nurse and Midwife Prescribing. Australian Nursing and Midwifery Federation. http://www.anmf.org.au/documents/policies/P_Registered_Nurse_and_Midwife_Prescribing.pdf. Published Feb 2018. Accessed March 30, 2020. 24Goodson C, Pethidine MR. To prescribe or not to prescribe? A discussion surrounding pethidine's place in midwifery practice and New Zealand prescribing legislation. N Zealand College Midwive J. 2014; 49: https://doi.org/10.12784/nzcomjnl49.2014.4.23-28 25 Washington Administrative Code 246-834-250. 26 Revised Code of Washington § 18.50.115. Citing Literature Volume48, Issue1March 2021Pages 4-13 ReferencesRelatedInformation
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