| (a) The governing body of each limited services rural
hospital (LSRH) shall adopt, implement, and enforce a policy relating
to patient transfers consistent with this section and contains each
of the requirements in subsection (b) of this section. The policy
shall identify LSRH staff that has authority to represent the LSRH
and the physician regarding transfers from the LSRH.
(b) The LSRH's governing body shall adopt the transfer
policy after consultation with the medical staff. The policy shall
apply to patient transfers to general and special hospitals licensed
under Texas Health and Safety Code (HSC) Chapter 241 (relating to
Hospitals) and private psychiatric hospitals licensed under HSC Chapter
577 (relating to Private Mental Hospitals and Other Mental Health
Facilities), as well as transfers to general, special, and private
psychiatric hospitals that are exempt from licensing.
(c) The LSRH's transfer policy shall govern transfers
not covered by a transfer agreement.
(d) The LSRH's transfer policy shall include a written
operational plan to provide for patient transfer transportation services
if the LSRH does not provide its own patient transfer transportation
services.
(e) The LSRH's governing body, after consultation with
the medical staff, shall implement its transfer policy by adopting
transfer agreements with hospitals in accordance with this section.
(f) The LSRH's transfer policy shall recognize and
comply with the requirements HSC Chapter 61 §§61.030 - 61.032
and §§61.057 - 61.059 (relating to Indigent Health Care
and Treatment Act).
(g) The LSRH's transfer policy shall acknowledge contractual
obligations and comply with statutory or regulatory obligations that
may exist concerning a patient and a designated provider.
(h) The LSRH's transfer policy shall require the LSRH
to take all reasonable steps 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:
(1) providing a factual explanation regarding:
(A) the increased medical risks to the patient reasonably
expected from not being transferred, examined, or treated at the transferring
hospital;
(B) any increased risks to the patient from not effecting
the transfer; and
(C) the medical benefits reasonably expected from the
provision of appropriate treatment at another hospital; and
(2) documenting the informed refusal of a patient,
or of a person acting on a patient's behalf, to examination, evaluation,
or transfer and obtaining, if possible, the signature of the patient
or the person acting on the patient's behalf, regarding the refusal
that is dated and witnessed by the attending physician or facility
employee, and placed in the patient's medical record.
(i) The LSRH's transfer policy shall recognize an individual's
right to request a transfer into the care of a physician and a hospital
of the individual's own choosing.
(j) The LSRH's transfer policy shall prohibit a patient
transfer from being 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.
(k) The LSRH's transfer policy shall require, when
a patient requests or consents to transfer for economic reasons and
the patient's choice is based on or influenced by representations
made by the transferring physician or LSRH administration regarding
the availability of medical care and hospital services at a reduced
cost or no cost to the patient, the physician or facility administration
to fully disclose to the patient the eligibility requirements established
by the patient's chosen physician or hospital.
(l) The LSRH's transfer policy shall provide that each
patient who arrives at the facility is:
(1) evaluated by a physician at the time the patient
presents or is presented or evaluated by a physician on-call who is:
(A) physically able to reach the patient within 30
minutes after being informed that a patient is present at the LSRH
who requires immediate medical attention; or
(B) accessible by direct, telephone, or radio communication
within 30 minutes with a registered nurse, physician assistant, or
other qualified medical personnel as established by the governing
body at the LSRH under orders to assess and report the patient's condition
to the physician; and
(2) personally examined and evaluated by the physician
before an attempt to transfer is made; however:
(A) after receiving a report on the patient's condition
from the LSRH's registered nurse, physician assistant, or other qualified
medical personnel as established by the governing body by telephone
or radio, if the physician on-call determines that an immediate transfer
of the patient is medically appropriate and that the time required
to conduct a personal examination and evaluation of a patient will
unnecessarily delay the transfer to the detriment of the patient,
the physician on-call may order the transfer by telephone or radio;
(B) physician orders for the transfer of a patient
which are issued by telephone or radio shall be reduced to writing
in the patient's medical record, signed by the registered nurse, physician
assistant, or other qualified medical personnel as established by
the governing body receiving the order, and countersigned by the physician
authorizing the transfer as soon as possible; and
(C) patient transfers resulting from physician orders
issued by telephone or radio shall be subject to automatic review
by the medical staff pursuant to subsection (q)(6) of this section.
(m) The transfer policies of the transferring LSRH
and receiving general or special hospital shall require the facilities
to have licensed nurses and other qualified personnel available and
on duty to assist with patient transfers. The policies shall require
written protocols or standing delegation orders to be in place to
guide facility personnel when a patient requires transfer to another
hospital.
(n) If a patient at an LSRH has an emergency medical
condition that has not been stabilized, or when stabilization of the
patient's vital signs is not possible because the LSRH does not have
the appropriate equipment or personnel to correct the underlying process,
the LSRH shall evaluate and treat the patient, then transfer the patient
as quickly as possible.
(o) The LSRH's transfer policy shall prohibit the LSRH
from transferring a patient with an emergency medical condition that
has not been stabilized unless:
(1) the individual (or a legally responsible person
acting on the individual's behalf), after being informed of the LSRH's
obligations under this section and of the risk of transfer, requests
the transfer in writing, indicates the reasons for the request, and
states the individual is aware of the risks and benefits of the transfer;
or
(2) a physician signs a certification, which includes
a summary of the risks and benefits based on the information available
at the time of transfer, the medical benefits reasonably expected
from the provision of appropriate medical treatment at another hospital
outweigh the increased risks to the patient and, in the case of labor,
to the unborn child from effecting the transfer.
(p) except as specifically provided in subsection (o)
of this section, the LSRH's 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 LSRH
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.
(q) The LSRH's transfer policy shall include the following
information related to physicians' duties and standard of care. The
policy shall require:
(1) the transferring physician to determine and order
life support measures that are medically appropriate to stabilize
the patient before transfer and to sustain the patient during transfer;
(2) the transferring physician to determine and order
the utilization of appropriate personnel and equipment for the transfer;
(3) the transferring physician, in determining the
use of medically appropriate life support measures, personnel, and
equipment, to exercise that degree of care which a reasonable and
prudent physician exercising ordinary care in the same or similar
locality would use for the transfer;
(4) except as allowed under subsection (o) of this
section, before each patient transfer, the physician who authorizes
the transfer to personally examine and evaluate the patient to determine
the patient's medical needs and to ensure that the proper transfer
procedures are used;
Cont'd... |
