| (a) General.
(1) The governing body of each facility shall adopt,
implement, and enforce a policy relating to patient transfers that
is consistent with this section and contains each of the requirements
in subsection (b) of this section. The policies shall identify facility
staff that has authority to represent the facility and the physician
regarding transfers from the facility.
(2) The governing body shall adopt the transfer policy
after consultation with the medical staff, and the transfer policy
shall apply to transfers to hospitals licensed under Texas Health
and Safety Code Chapter 241 (relating to Hospitals) and Chapter 577
(relating to Private Mental Hospitals and Other Mental Health Facilities),
as well as transfers to hospitals that are exempt from licensing.
(3) The transfer policy shall govern transfers not
covered by a transfer agreement.
(4) The transfer policy shall include a written operational
plan to provide for patient transfer transportation services if the
facility does not provide its own patient transfer transportation
services.
(5) The governing body, after consultation with the
medical staff, shall implement its transfer policy by adopting transfer
agreements with hospitals in accordance with §509.66 of this
subchapter (relating to Patient Transfer Agreements).
(6) The transfer policy shall recognize and comply
with the applicable requirements of Texas Health and Safety Code Chapter
61 (relating to Indigent Health Care and Treatment Act).
(7) The transfer policy shall acknowledge contractual
obligations and comply with statutory or regulatory obligations that
may exist concerning a patient and a designated provider.
(8) The transfer policy shall require that all reasonable
steps are taken to secure the written informed consent of a patient,
or a person acting on a patient's behalf, when refusing a transfer
or related examination and treatment. Reasonable steps include:
(A) a factual explanation of the increased medical
risks to the patient reasonably expected from not being transferred,
examined, or treated at the transferring hospital;
(B) a factual explanation of any increased risks to
the patient from not effecting the transfer; and
(C) a factual explanation of the medical benefits reasonably
expected from the provision of appropriate treatment at another hospital.
(9) The informed refusal of a patient, or a person
acting on a patient's behalf, to examination, evaluation, or transfer
shall be documented and signed if possible by the patient or by a
person acting on the patient's behalf, dated and witnessed by the
attending physician or facility employee, and placed in the patient's
medical record.
(10) The transfer policy shall recognize the right
of an individual to request a transfer into the care of a physician
and a hospital of the individual's own choosing.
(b) Requirements for transfer of patients from facilities
to hospitals.
(1) The transfer policy shall provide that the transfer
of a patient may not be predicated upon arbitrary, capricious, or
unreasonable discrimination based upon race, religion, national origin,
age, sex, physical condition, economic status, insurance status, or
ability to pay.
(2) The transfer policy shall recognize the right of
an individual to request transfer into the care of a physician and
hospital of the individual's own choosing; however, if a patient requests
or consents to transfer for economic reasons and the patient's choice
is predicated upon or influenced by representations made by the transferring
physician or facility administration regarding the availability of
medical care and hospital services at a reduced cost or no cost to
the patient, physician or facility administration shall fully disclose
to the patient the eligibility requirements established by the patient's
chosen physician or hospital.
(3) The transfer policy shall provide that each patient
who arrives at the facility is:
(A) evaluated by a physician at the time the patient
presents; and
(B) personally examined and evaluated by the physician
before an attempt to transfer is made.
(4) The policy of the transferring facility and receiving
hospital shall provide that licensed nurses and other qualified personnel
are available and on duty to assist with patient transfers. The policy
shall provide that written protocols or standing delegation orders
are in place to guide facility personnel when a patient requires transfer
to another hospital.
(5) Special requirements related to the transfer of
patients who have emergency medical conditions:
(A) If a patient at a facility has an emergency medical
condition that has not been stabilized, or when stabilization of the
patient's vital signs is not possible because the facility does not
have the appropriate equipment or personnel to correct the underlying
process, the facility shall evaluate and treat the patient and transfer
the patient as quickly as possible.
(B) The transfer policy shall provide that the facility
may not transfer a patient with an emergency medical condition that
has not been stabilized unless:
(i) the individual or the individual's legally authorized
representative, after being informed of the facility's obligations
under this section and the risk of transfer, requests the transfer,
in writing, and indicates the reasons for the request, as well as
that he or she is aware of the risks and benefits of the transfer;
or
(ii) a physician has signed a certification, which
includes a summary of the risks and benefits, that, based on the information
available at the time of transfer, the medical benefits reasonably
expected from the provision of appropriate medical treatment at a
hospital outweigh the increased risks to the patient and, in the case
of labor, to the unborn child from effecting the transfer.
(C) Except as is specifically provided in subsection
(a)(6) and (7) of this section, the transfer policy shall provide
that the transfer of patients who have emergency medical conditions,
as determined by a physician, shall be undertaken for medical reasons
only. The facility must provide medical treatment within its capacity
that minimizes the risks to the individual's health and, in the case
of a woman in labor, the health of the unborn child.
(6) The transfer policy shall provide for the following
physician's duties and standard of care requirements.
(A) The transferring physician shall determine and
order life support measures that are medically appropriate to stabilize
the patient before transfer and to sustain the patient during transfer.
(B) The transferring physician shall determine and
order the utilization of appropriate personnel and equipment for the
transfer.
(C) In determining the use of medically appropriate
life support measures, personnel, and equipment, the transferring
physician shall exercise that degree of care that a reasonable and
prudent physician exercising ordinary care in the same or similar
locality would use for the transfer.
(D) Except as allowed under paragraph (5)(B) of this
subsection, before each patient transfer, the physician who authorizes
the transfer shall personally examine and evaluate the patient to
determine the patient's medical needs and to ensure that the proper
transfer procedures are used.
(E) Before transfer, the transferring physician shall
ensure that a receiving hospital and physician that are appropriate
to the medical needs of the patient have accepted responsibility for
the patient's medical treatment and hospital care.
(7) The facility's medical staff shall review appropriate
records of patients transferred from the facility to determine that
the appropriate standard of care has been met.
(8) A facility shall comply with the following medical
record requirements.
(A) The facility's policy shall require that a copy
of those portions of the patient's medical record that are available
and relevant to the transfer and to the continuing care of the patient
be forwarded to the receiving physician and receiving hospital with
the patient. If all necessary medical records for the continued care
of the patient are not available at the time the patient is transferred,
the records shall be forwarded to the receiving physician and hospital
as soon as possible.
(B) The medical record shall contain at least:
(i) a brief description of the patient's medical history
and physical examination;
(ii) a working diagnosis and recorded observations
of physical assessment of the patient's condition at the time of transfer;
(iii) the reason for the transfer;
(iv) the results of all diagnostic tests, such as laboratory
tests;
(v) pertinent radiological films and reports; and
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