Current through Register 1531, September 27, 2024
(1)104 CMR
27.08 governs the transfer of patients pursuant to M.G.L. c. 123, § 3 and
the transport of patients pursuant to M.G.L. c. 123, § 21.
(2) For the purposes of 104 CMR 27.08(3)
through (8), "emergency" shall mean those medical, surgical and psychiatric
crises which, in the opinion of the facility director, threaten the safety,
health or life of the patient or others, and which could not be appropriately
treated in the transferring facility.
(3)
Permitted Transfers;
Exceptions. Any patient admitted to a facility may be transferred
from that facility to any other facility, provided that except in an emergency:
(a) Patients on voluntary status under
104 CMR
27.06 shall not be subject to transfer
without their written consent; and
(b) Patients on conditional voluntary status
under
104 CMR
27.06 may refuse transfer. Such refusal may
be considered equivalent to submission of the patient's three-day written
notice of his or her intention to leave or withdraw from the facility. Upon
such refusal, the facility director may file a petition for commitment under
the provisions of M.G.L. c. 123, §§ 7 and 8 if the patient meets the
criteria for commitment, or may withdraw the notice of transfer provided to the
patient pursuant to 104 CMR 27.08(9).
(4) Absent an emergency, a patient 16 years
of age or older on conditional voluntary status at a facility may not be
transferred from that facility over his or her objection, or in the case of a
minor, or a patient admitted by health care agent pursuant to a properly
invoked and affirmed health care proxy, over the objection of such minor or
patient's legally authorized representative, unless a court of competent
jurisdiction enters a commitment order pursuant to M.G.L. c. 123, §§
7 and 8.
(5) Absent an emergency, a
patient younger than 16 years old who has been admitted to a facility pursuant
to his or her legally authorized representative's authority, may not be
transferred from that facility over the objection of the legally authorized
representative, unless a court of competent jurisdiction enters a commitment
order pursuant to M.G.L. c. 123, §§ 7 and 8.
(6) In no event shall an application for
admission pursuant to M.G.L. c. 123, § 12(a) be issued in order to
transfer a patient in lieu of compliance with the requirements
of M.G.L. c. 123, § 3, and 104 CMR 27.08.
(7) Patients transferred pursuant to M.G.L.
c. 123, § 3, and 104 CMR 27.08 shall be admitted to the receiving facility
under the same legal status pursuant to which the patient was hospitalized at
the transferring facility. Transfer of a patient committed pursuant to M.G.L.
c. 123 shall not extend the period of such commitment.
(8) A patient who is admitted or committed to
a facility licensed pursuant to
104 CMR 27.00, who is
transferred to a medical facility for treatment of a medical condition during
the period of his or her admission or commitment, may be readmitted to the
transferring facility under the same legal status pursuant to which the patient
was admitted or committed to the transferring facility; provided however, that
for a patient who is committed pursuant to a court order, such court order has
not expired at the time of readmission.
(9)
Transfer
Procedures.
(a) The approval of
the director of the receiving facility shall be obtained by the transferring
facility.
(b) The director of the
transferring facility shall give six days written notice to the patient to be
transferred and, if applicable, to his or her legally authorized
representative; provided however, that if such transfer must be made
immediately because of an emergency, notice shall be given within 24 hours
after the transfer pursuant to M.G.L. c. 123, § 3. The notice, which shall
include the patient or legally authorized representative's right to object as
provided in 104 CMR 27.08(4) and (5), shall be provided in a form prescribed by
the Department.
(c) The director
shall inform the patient that notice of transfer shall also be given to his or
her nearest relative; unless the patient knowingly objects.
(d) A patient or a legally authorized
representative with authority to admit the patient to a psychiatric facility
may waive the six days notice requirement.
(e) A copy of the notice of transfer, along
with a copy of the patient's underlying admission status documentation, shall
accompany the patient to the receiving facility.
(10)
Transport of Patients
Admitted to a Facility; Limitations of Use of Restraint.
(a) The transport of a patient in a facility
may be authorized by the facility director, or designee, on a form approved by
the Department, for the following purposes:
1.
Transfer to another facility pursuant to M.G.L. c. 123, § 3;
2. Movement among separate campuses of a
single facility;
3. Evaluation
and/or treatment at a medical facility or office and return to the
facility;
4. Attendance at court
proceedings and return to the facility;
5. Transfer to or from another state pursuant
to the Interstate Compact on Mental Health, M.G.L. c. 123, App. §§
1-1 through 1-4; and
6. Other
destinations with the approval of the facility director or designee.
(b) Restraint of a patient in a
facility by or under the supervision of the facility's staff may not be used in
the course of transport, unless such restraint is necessary for the safety of
the patient being transported or of others who are likely to come into contact
with the patient being transported. Such restraint must be by the least
restrictive method to assure the safety of the patient or others in accordance
with 104 CMR 27.08(10). Such restraint must be authorized by a clinician
authorized to order restraint pursuant to
104
CMR 27.12(8)(a)1., or in an
emergency when an authorized clinician is not available, by a staff person
authorized to initiate restraint pursuant to
104
CMR 27.12(8)(a)2.
1. If the patient is being transported by the
facility, or under the supervision of the facility's staff, then the
clinician's authorization shall describe the circumstances under which
restraint may be used in the course of transport and method of restraint that
may be employed.
a. No locked mechanical
restraint devices requiring the use of a key for their release may be used in
the course of transport.
b. Only
restraint procedures or devices that have been approved by the facility for
such purposes may be used for restraint during transport, and monitoring staff
must have received appropriate training on such approved procedures and
devices.
c. No patient shall be
placed in restraints in the course of transport, unless a staff member is
assigned to provide one-to-one monitoring as provided in
104
CMR 27.12(8)(h)1. through
6.
d. During the transport, the
monitoring staff person must carry a copy of the form which authorizes the
restraint during transport.
e. The
driver of the vehicle in which the patient is being transported may not be
assigned to provide such monitoring.
f. No staff member who has not been trained
in accordance with
104
CMR 27.12(3) may be
authorized to apply restraints to a patient in the course of transport, or to
monitor a patient who is in restraints in the course of transport.
g. Except as provided in 104 CMR 27.08(10)(c)
and (d), restraint ordered pursuant to 104 CMR 27.08(10) may only last while
the patient is under the supervision of facility staff, and shall terminate if
the patient is admitted to a medical facility, including the emergency
department of such medical facility for evaluation or treatment.
(c) If the patient is
being transported by ambulance, then restraint may be used only in accordance
with M.G.L. c. 111C, § 18.
(d)
Nothing in 104 CMR 27.08(10) shall be deemed to regulate the use of restraint
by licensed law enforcement personnel in the transport of patients in the
custody of such personnel.
(e) The
use of seatbelts or a "child safety door lock" shall not be considered
restraint for purposes of 104 CMR 27.08(10).
(f) Where the need for restraint during
transport for purposes described in 104 CMR 27.08(10)(a) is anticipated,
consideration should be given to delaying such transport until such patient no
longer requires restraint, if such delay is reasonable.
(g) Unless the patient is fully discharged
prior to transport, a patient transported pursuant to 104 CMR 27.08(10) shall
remain on the admission status under which the patient was admitted to the
facility, until such time as the patient is fully discharged from the facility;
provided however, that an order of transport pursuant to 104 CMR 27.08(10)
shall not extend any relevant time period including, but not limited to,
expiration of a commitment order, for such admission.
