CR 53.4
             PROCEDURES FOR MANDATORY MEDIATION OF HEALTH CARE
                                  CLAIMS

(a)  Scope of Rule. This rule governs the procedure in the superior court
     in all claims subject to mandatory mediation under RCW 7.70.100 and
     .110.

(b)  Voluntary Mediation. The parties may establish a procedure for
     mediation that differs from this rule provided the procedure and the
     selection of the mediator are agreed to in writing and signed by all
     parties.

(c)  Deadlines. Except as otherwise ordered by the court for good cause
     shown, mediation under RCW 7.70.100 shall be commenced no later than
     30 days before the trial date. Mediation under RCW 7.70.110 shall be
     commenced no later than 90 days after the selection of the mediator.

(d)  Waiver of Mediation. Upon petition of any party that mediation is not
     appropriate, the court shall order or the mediator may determine that
     the claim is not appropriate for mediation.

(e)  Appointment of Mediator. Subject to the conditions in this section,
     the court shall designate a mediator from the register described in
     section (g) upon the request of any party. Except upon stipulation in
     writing signed by all parties, the court shall not make this
     designation if the parties have agreed in writing to the selection of
     a mediator as contemplated by section (b) or have obtained a waiver
     of mediation under section (d). Except upon stipulation in writing
     signed by all parties, the court shall designate a mediator no sooner
     than 180 days before trial, or for mediation requested under RCW
     7.70.100, no sooner than 180 days after the good faith request for
     mediation.

(f)  Mediation Procedure. Promptly upon the designation of a mediator, the
     plaintiff shall arrange a conference call among the mediator and
     counsel for each party to discuss the procedural aspects of the
     mediation. Except to the extent the mediator directs otherwise, the
     following procedures shall apply:

     (1)  Copy of Pleadings. Upon selection of a mediator, the parties
          shall provide the mediator with copies of the relevant
          Pleadings.

     (2)  Notice of Time and Place. The mediator shall fix a time and
          place for the mediation conference, and all subsequent sessions,
          that is reasonably convenient for the parties and shall give
          them at least 14 days' written notice of the initial conference.
          In giving notice the mediator may use a form provided by the
          court.

     (3)  Memoranda. Each party shall provide the mediator with a
          confidential memorandum presenting in concise form its
          contentions relative to both liability and damages. This
          memorandum shall not exceed 10 pages in length. A copy of the
          memorandum shall be delivered to the mediator at least seven
          days before the mediation conference. Any party may deliver a
          copy of his or her memorandum to any other party. In addition,
          each party shall deliver to the mediator a confidential
          statement of its current offer or demand. Any party may deliver
          a copy of his or her statement to any other party.

     (4)  Attendance and Preparation Required. The attorney who is
          primarily responsible for each party's case shall personally
          attend the mediation conference and any subsequent sessions of
          that conference. The attorney for each party shall come prepared
          to discuss the following matters in detail and in good faith:

          (A)  All liability issues.

          (B)  All damage issues.

          (C)  The position, of his or her client relative to settlement.

     (5)  Attendance of Parties and Insurers. For purposes of this
          section, "insurer" shall include "self insurer." In addition to
          counsel, all parties and insurers shall attend the mediation in
          person. In the event a party defendant has provided his or her
          insurer with full authority to settle, such party's attendance
          is optional. The mediator may also, at his or her discretion,
          but only in exceptional cases, excuse a party or insurer from
          personally attending the mediation conference. Those excused
          from personal attendance by the mediator shall be on call by
          telephone during the conference.

     (6)  Failure to Attend. Willful or negligent failure to attend the
          mediation conference, or to comply with this rule or with the
          directions of the mediator, shall be reported to the court by
          the mediator in writing and may result in the imposition of such
          sanctions as the court may find appropriate.

     (7)  Proceedings Privileged. All proceedings of the mediation
          conference, including any statement made by any party, attorney
          or other participant, shall, in all respects, be privileged and
          not reported, recorded, placed in evidence, used for
          impeachment, made known to the trial court or jury, or construed
          for any purpose as an admission. No party shall be bound by
          anything done or said at the conference unless a settlement is
          reached, in which event the agreement upon a settlement shall be
          reduced to writing and shall be binding upon all parties to that
          agreement.

     (8)  Mediator's Suggestions. The mediator shall have no obligation to
          make any written comments or recommendations, but may in his or
          her discretion provide the parties or their counsel with a
          confidential written settlement recommendation memorandum, but
          only if all parties agree. No copy of any such memorandum shall
          be filed with the clerk or made available, in whole or in part,
          directly or indirectly, either to the court or to the jury.

     (9)  Certification of Mediation. Not more than 10 days after the
          mediation concludes or the mediator determines that the claim is
          not appropriate for mediation, the parties shall certify in
          writing to the court the manner of mediation, if any, and
          compliance with the provisions of this rule.

(g)  Register of Volunteer Mediators.

     (1)  Court to Maintain Register. The court shall establish and
          maintain a register of qualified attorneys who have volunteered
          to serve as mediators. The attorneys so registered shall be
          selected by the court from lists of qualified attorneys at law
          who are current members in good standing of the Washington State
          Bar Association.

     (2)  Qualifications. In order to qualify as a mediator, an attorney
          shall:

          (A)  Have been a member of the Washington State Bar Association
               for at least five years; and

          (B)  Have experience or expertise related to litigating actions
               arising from injury occurring as a result of health care;
               and

          (C)  Have 6 hours of CLE mediator training and acted as a
               mediator in at least 10 cases, three of which were medical
               malpractice; or

          (D)  Be a retired judge having experience or expertise related
               to actions arising from injury occurring as a result of
               health care and satisfy the requirements of (2)(C) herein.

131 Wn.2d 104-266, 1101, [Effective March 11, 1997; amended September 1,
2007.]