| (a) A limited services rural hospital (LSRH) shall
limit the surgical procedures performed at the LSRH to procedures
the governing body approved upon the medical staff's recommendation.
(b) Adequate supervision of surgical procedures conducted
in the LSRH shall be:
(1) a responsibility of the governing body;
(2) recommended by medical staff; and
(3) provided by appropriate medical staff.
(c) An LSRH shall only perform surgical procedures
when:
(1) a physician, dentist, podiatrist, or other practitioner
licensed to perform surgical procedures in Texas performs the procedure;
(2) the governing body granted privileges to the physician,
dentist, podiatrist, or other practitioner, practicing within the
scope of their license and education, to perform surgical procedures;
(3) the LSRH's medical staff recommended the surgical
procedure; and
(4) the governing body has medically reviewed the physician's,
dentist's, podiatrist's, or other practitioner's documented education,
training, experience, and current competence.
(d) An LSRH shall periodically review surgical procedures
to be performed in the LSRH as part of the peer review portion of
the LSRH's quality assessment and performance improvement program
by physically observing planned surgical procedures.
(e) An LSRH shall incorporate an appropriate patient
history, physical examination, and pertinent preoperative diagnostic
studies into the patient's medical record before surgical procedures.
(f) Unless otherwise provided by law, the LSRH shall
discuss the proposed surgical procedure's necessity or appropriateness,
as well as any available alternative treatment techniques, with the
patient or the patient's legally authorized representative, as applicable,
before the surgical procedure.
(g) Unless otherwise provided by law, the LSRH shall
obtain the informed consent of the patient or, if applicable, of the
patient's legally authorized representative before a surgical procedure
is performed. When the LSRH is unable to obtain informed consent before
an emergency surgery, the LSRH shall document in the patient's medical
record the reason or reasons why the LSRH was unable to obtain the
informed consent.
(h) With the exception of those tissues exempted by
the governing body after medical review, a pathologist shall examine
tissues removed and sign or authenticate the report of the examination
for the patient's medical record.
(i) A description of the findings and techniques of
surgical procedures shall be accurately and completely incorporated
into the patient's medical record immediately after the procedure
by the physician or practitioner who performed the procedure. If the
description is dictated, an accurate written summary shall be immediately
available to the physicians and practitioners providing patient care
and shall become a part of the patient's medical record.
(j) The LSRH shall allow patients who have received
anesthesia, other than solely topical anesthesia, to leave the facility
only in the company of a responsible adult, unless the physician,
physician assistant, or an advanced practice registered nurse writes
an order that the patient may leave without the company of a responsible
adult.
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