(a) Surgical abortion.
(1) The medical consultant shall be responsible for
implementing and supervising the medical and clinical policies of
the facility.
(2) All medical and clinical services of the facility,
with the exception of the abortion procedure, shall be provided under
the direction of a physician or registered nurse who assumes responsibility
for the clinical employees' performance in the facility.
(3) A licensed abortion facility shall ensure that
a surgical consent form is signed by the patient prior to the procedure
being started, that the patient is informed of the risks and the benefits
of the procedure, and that the patient recognizes the alternatives
to abortion. Informed consent shall be in accordance with rules adopted
by the Texas Medical Disclosure Panel under §601.2 of this title
(relating to Procedures Requiring Full Disclosure of Specific Risks
and Hazards--List A), §601.4 of this title (relating to Disclosure
and Consent Form), and Health and Safety Code §171.011 (relating
to Informed Consent Required), and §171.012 (relating to Voluntary
Informed Consent).
(4) A licensed abortion facility shall ensure that
the attending physician, advanced practice registered nurse, or physician
assistant has obtained and documented a preoperative history, physical
exam, and laboratory studies, including verification of pregnancy.
(5) A licensed abortion facility shall ensure that:
(A) the attending physician examines each patient immediately
prior to surgery to evaluate the risk to the procedure; and
(B) the person administering the anesthetic agent(s)
examines the patient immediately prior to surgery to evaluate the
risk of anesthesia.
(6) The administration of anesthesia shall be in accordance
with §139.59 of this subchapter (relating to Anesthesia Services).
(7) A surgical abortion shall be performed only by
a physician.
(8) A physician, advanced practice registered nurse,
physician assistant, registered nurse, or licensed vocational nurse
shall be in the facility whenever there is a patient in the procedure
room or recovery room. While a patient is in the procedure room or
recovery room she shall not be left unattended.
(9) The recovery room(s) at the facility shall be supervised
by a physician, advanced practice registered nurse, physician assistant,
or registered nurse. This supervisor shall be available for recovery
room staff within a recommended 10 minutes with a maximum required
15 minutes while any patient is in the recovery room.
(10) A physician shall be available for the facility
while any patient is in the recovery room within a recommended 10
minutes and a maximum required 15 minutes.
(11) The facility shall ensure that a patient is fully
reactive and her vital signs are stable before discharging the patient
from the facility upon written order by the attending physician.
(12) All fetal tissue shall be examined grossly at
the time of the procedure. In the absence of visible fetal parts or
placenta, the tissue may be examined by magnification for the detection
of villi. If this examination is inconclusive, the tissue shall be
sent to a pathology lab. The results of the tissue examination shall
be recorded in the patient's clinical record.
(13) A facility shall meet the requirements set forth
by the department in §§1.131 - 1.137 of this title (relating
to Definition, Treatment, and Disposition of Special Waste from Health
Care-Related Facilities).
(b) Medical abortion.
(1) The medical consultant shall be responsible for
implementing and supervising the medical and clinical policies of
the facility.
(2) All medical and clinical services of the facility,
with the exception of the abortion procedure, shall be provided under
the direction of a physician or registered nurse who assumes responsibility
for the clinical employees' performance in the facility.
(3) A licensed abortion facility shall ensure:
(A) the physician(s) providing medical abortion is
able to accurately date a pregnancy;
(B) the physician(s) is able to determine that the
pregnancy is not an ectopic gestation;
(C) the physician(s) is able to provide surgical intervention
or provide for the patient to receive a surgical abortion if necessary;
and
(D) patients have access to medical facilities equipped
to provide blood transfusion and patient resuscitation, if necessary.
(4) A licensed abortion facility shall ensure follow-up
examination and services are provided to patients requesting medical
abortion.
(5) A licensed abortion facility shall ensure that
the attending physician, advanced practice registered nurse, or physician
assistant has obtained and documented a pre-procedure history, physical
exam, and laboratory studies, including verification of pregnancy.
(6) A licensed abortion facility shall ensure:
(A) written consent is obtained from the patient prior
to the commencement of the abortion procedure in accordance with §139.50
of this chapter (relating to Disclosure Requirements);
(B) the patient is informed of the risks and benefits
of the procedure;
(C) the patient is informed of the possibility that
a surgical abortion may be required;
(D) the patient is informed of the alternatives to
abortion; and
(E) informed consent is in accordance with rules adopted
by the Texas Medical Disclosure Panel under §601.2 of this title, §601.4
of this title, and Health and Safety Code §171.011 and §171.012.
(7) A licensed abortion facility shall provide the
patient with written discharge instructions including a direct referral
to a physician who shall accept the patient for surgical abortion.
(8) A medical abortion shall be performed only by a
physician.
(c) Requirements of a physician. A physician performing
or inducing an abortion must, on the date the abortion is performed
or induced, have active admitting privileges at a hospital that:
(1) is located not further than 30 miles from the location
at which the abortion is performed or induced; and
(2) provides obstetrical or gynecological health care
services.
|
Source Note: The provisions of this §139.53 adopted to be effective June 28, 2009, 34 TexReg 4125; amended to be effective January 1, 2014, 38 TexReg 9577; amended to be effective November 24, 2022, 47 TexReg 7696 |