| (A) If a patient at a hospital has an emergency medical condition which has not been stabilized or when stabilization of the patient's vital signs is not possible because the hospital or emergency treatment area does not have the appropriate equipment or personnel to correct the underlying process (e.g. children's hospitals, thoracic surgeon on staff, or cardiopulmonary bypass capability), evaluation and treatment shall be performed and transfer shall be carried out as quickly as possible. (B) The hospital's policy shall provide that the hospital may not transfer a patient with an emergency medical condition which has not been stabilized unless: (i) the individual (or a legally responsible person acting on the individual's behalf), after being informed of the hospital's obligations under this section and of 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; (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 another hospital outweigh the increased risks to the patient and, in the case of labor, to the unborn child from effecting the transfer; or (iii) if the physician who made the determination to transfer a patient with an emergency condition is not physically present in the emergency treatment area at the time of transfer, a qualified medical person may sign a certification described in clause (ii) of this subparagraph after consultation with the physician. The physician shall countersign the physician certification within a reasonable period of time. (C) Except as is specifically provided in subsection (b)(8) and (9) of this section, the hospital'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 hospital 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. (D) A hospital that has specialized capabilities or facilities (including, but not limited to such facilities as burn units, shock-trauma units, neonatal intensive care units, or, with respect to rural areas, regional referral centers) may not refuse to accept from a referring hospital an appropriate transfer of an individual who requires such specialized capabilities or facilities if the receiving hospital has the capacity to treat the individual. Except as expressly permitted in clauses (i) and (ii) of this subparagraph, a hospital's policy shall provide for the receipt of patients who have an emergency medical condition from other hospitals so that upon notification from a transferring physician or a transferring hospital prior to transfer, the receiving hospital shall respond to the transferring hospital and transferring physician with the status of the transfer request within 30 minutes and either accept or refuse the transfer. The time period begins to run at the time a member of the staff of the receiving hospital receives the call initiating the request to transfer. (i) The receiving hospital's policy may permit response to the transferring hospital and transferring physician within a period of time in excess of 30 minutes but no longer than one hour if there are extenuating circumstances for the delay. If the transfer is accepted, the reason for the delay shall be documented on the memorandum of transfer. (ii) The response time may be extended before the expiration of the initial 30 minutes period by agreement among the transferring hospital and transferring physician and the receiving hospital and receiving physician. If the transfer is accepted, the agreed extension shall be documented in the memorandum of transfer. (7) Physician's duties and standard of care. (A) The policy shall provide that the transferring physician shall determine and order life support measures which are medically appropriate to stabilize the patient prior to transfer and to sustain the patient during transfer. (B) The policy shall provide that the transferring physician shall determine and order the utilization of appropriate personnel and equipment for the transfer. (C) The policy shall provide that in determining the use of medically appropriate life support measures, personnel, and equipment, the transferring physician shall 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. (D) The policy shall provide that except as allowed under paragraph (4)(B) of this subsection, prior to 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) The policy shall provide that prior to 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. (8) Record review for standard of care. The hospital's policy shall provide that the hospital's medical staff review appropriate records of patients transferred from the hospital to determine that the appropriate standard of care has been met. (9) Medical record. (A) The hospital's policy shall provide that a copy of those portions of the patient's medical record which 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 a minimum: (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 X-ray films and reports; and (vi) any other pertinent information. (10) Memorandum of transfer. (A) The hospital's policy shall provide that a memorandum of transfer be completed for every patient who is transferred. (B) The memorandum shall contain the following information: (i) the patient's full name, if known; (ii) the patient's race, religion, national origin, age, sex, physical handicap, if known; (iii) the patient's address and next of kin, address, and phone number if known; (iv) the names, telephone numbers and addresses of the transferring and receiving physicians; (v) the names, addresses, and telephone numbers of the transferring and receiving hospitals; (vi) the time and date on which the patient first presented or was presented to the transferring physician and transferring hospital; (vii) the time and date on which the transferring physician secured a receiving physician; (viii) the name, date, and time hospital administration was contacted in the receiving hospital; (ix) signature, time, and title of the transferring hospital administration who contacted the receiving hospital; (x) the certification required by paragraph (6)(B)(ii) of this subsection, if applicable (the certification may be part of the memorandum of transfer form or may be on a separate form attached to the memorandum of transfer form); (xi) the time and date on which the receiving physician assumed responsibility for the patient; (xii) the time and date on which the patient arrived at the receiving hospital; (xiii) signature and date of receiving hospital administration; (xiv) type of vehicle and company used; (xv) type of equipment and personnel needed in transfers; (xvi) name and city of hospital to which patient was transported; (xvii) diagnosis by transferring physician; and (xviii) attachments by transferring hospital. (C) The receipt of the memorandum of transfer shall be acknowledged in writing by the receiving hospital administration and receiving physician. Cont'd... |
