Current through Register Vol. 46, No. 39, September 25, 2024
(a)
Who may
apply for order.
Application for an order of transfer for a patient may be
made by the patient, by a significant other or guardian of the patient, or by
the sending hospital's director or the designee thereof.
(b)
Content of application.
(1) Written application for an order of
transfer should be made on Forms A and B in subdivisions (k)-(l) of this
section. Such application shall include the following:
(i) the reasons for the application,
indicating how the patient is expected tobenefit from the transfer;
(ii) the name and address of the applicant
and the applicant's relationship to the patient;
(iii) the name of the hospital where the
patient currently resides and the name of the hospital to which transfer is
proposed;
(iv) the age of the
patient;
(v) the admission status
of the patient;
(vi) the written
consent of the patient (or the patient's parent or guardian, if appropriate) or
a summary of the appeal procedure and result (see paragraph [c][3] of this
section); and
(vii) the written
consent of the receiving hospital, if application is not being made directly to
the receiving hospital.
(2) If the sending hospital's director or the
designee thereof is the applicant, the application should additionally include
the following material
(i) a summary of the
patient's clinical record to date;
(ii) the results of all pertinent physical
and laboratory examinations; and
(iii) all pertinent legal
documents.
(3) If the
receiving hospital is a State-operated psychiatric center,and the patient is
under 21 years of age and is a recipient of medical assistance, the application
should additionally include a certification of the need for continued inpatient
treatment. Such certification shall be made on forms approved by the Office of
Mental Health.
(i) The certification of need,
completed by the sending hospital, shall include a written attestation of the
following:
(a) ambulatory care resources
available in the community do not meet the treatment needs of the
patient;
(b) proper treatment of
the patient's psychiatric condition requires services on an inpatient basis
under the direction of a physician; and
(c) continued inpatient treatment can
reasonably be expected to improve the patient's condition or prevent further
regression so that the services will no longer be needed.
(ii) The certification of need form shall be
completed by a team of two or more individuals who are independent of the
receiving hospital or related agency. Such team, which has knowledge of the
individual's situation, and has competence in the diagnosis and treatment of
mental illness, preferably in child psychiatry, shall include a
physician.
(iii) If the sending
hospital applied for medical assistance on behalf of the patient, but the
patient's status as a recipient of medical assistance is not confirmed at the
time of transfer, the application for an order of transfer shall also include a
copy of any certification of need form completed by the sending hospital during
the process of applying for medical assistance.
(iv) If it is determined that the transfer of
a patient is necessary in order to prevent serious impairment or deterioration
of the health of the patient, or to prevent immediate serious physical harm to
the patient or others, the sending hospital is not required to complete a
certification of need form. In such cases, the receiving hospital shall
complete the certification of need form within 14 days after the patient's
admission to the receiving hospital.
(4) If the receiving hospital is a
free-standing psychiatric hospitalother than a State-operated psychiatric
center, and the sending hospital is a State-operated psychiatric center, the
sending hospital shall include a certification of need in the application for
an order of transfer of a patient who is under 21 years of age and is a
recipient of medical assistance.
(i) The
certification of need shall be completed as described in subparagraphs
(3)(i)-(iii) of this subdivision.
(ii) If it is determined that the transfer of
a patient is necessary in order to prevent serious impairment or deterioration
of the health of the patient, or to prevent immediate serious physical harm to
the patient or others, the sending hospital is not required to complete a
certification of need form.
(c)
Consent of patient.
(1) Voluntary and informal patients. An order
of transfer may be requested for a voluntary or informal patient only with the
patient's written consent.A voluntary patient who refuses to consent to a
transfer may be:
(i) retained as a voluntary
patient;
(ii) discharged, if
appropriate, in accordance with a service plan prepared for the patient
pursuant to section 29.15 of the Mental Hygiene Law;
or
(iii) converted to involuntary
status and thereafter transferred, if the following conditions are satisfied:
(a) the patient meets the criteria for
involuntary retention;
(b) the
patient's best interests would be served by transfer to another hospital, based
on the criteria established in paragraph (d)(1) of this section; and
(c) all other requirements established in
this section which are applicable to the transfer of such patient are complied
with.
(2)
Minor voluntary patients. A voluntary patient under 18 years of age who was
admitted on the patient's own application must provide written consent to the
transfer. In the case of a voluntary patient under 18 years of age who was not
admitted on the patient's own application, that patient's parent or guardian
must provide written consent to the transfer.
(3) Involuntary patients. An order of
transfer may be requested for any involuntary patient. The proposed transfer
shall first be discussed with the patient. No request for the transfer of an
objecting patient shall be made by the sending hospital until such patient has
been given an opportunity to appeal such request to the sending hospital's
director.
(i) Appeal. The director of the
sending hospital may designate the clinical director, any unit chief or
psychiatrist not of the unit where the patient receives or has received care,
or any supervisor of such unit chief or psychiatrist, to hear an appeal. The
patient may elect to have a person represent him or her. The appeal may be
conducted informally, without adhering to the rules of evidence and
record-keeping. The director or the designee thereof shall:
(a) review the patient's clinical
history;
(b) give the patient, the
Mental Hygiene Legal Service and any patient representative an opportunity to
discuss the patient's objections to the transfer with the director or the
designee thereof; and
(c) consider
the criteria for transfer described in subdivision (d) of this section and
determine whether, on balance, the patient's best interests would be served by
transfer to another hospital.
(ii) Upon completion of the appeal, the
director or the designee thereof shall inform the patient, the MHLS and any
patient representative of the results. If the patient is still to be
transferred, the sending hospital may request an order of transfer and shall
inform the patient, the MHLS and any patient representative of the anticipated
date of transfer, when known.
(d)
Criteria for transfer.
(1) Suitability of the hospital. Transfer of
a patient between hospitals shall be authorized when it is determined to be in
the best interests of the patient. In making the determination of which
hospital better serves the best interests of the patient, the following factors
shall be considered:
(i) The patient's need
for continued inpatient treatment.
(ii) The patient's need for services which
are more readily available or which can be more effectively provided at the
receiving hospital.
(iii) Proximity
of the sending and receiving hospitals to the patient's significant
others.
(iv) The ability of the
sending hospital to provide adequate overall treatment of the patient, as
affected by:
(a) overcrowding;
(b) reduction or elimination of services
beneficial to the patient; and
(c)
reduction in the number of approved beds.
(v) The ability of the receiving hospital to
provide adequate overall treatment of the patient, as affected by:
(a) overcrowding;
(b) the availability of services beneficial
to the patient; and
(c) bed
capacity.
(2)
Suitability of the patient.
(i) The patient
must meet the psychiatric admissions criteria of the receiving
hospital.
(ii) In addition to
satisfying subparagraph (i) of this paragraph, a patient to be transferred from
a municipal or general hospital in New York City to a hospital operated by the
Office of Mental Health must satisfy the following requirements, unless waived
by the commissioner or a designee thereof:
(a)
the patient must not require acute psychiatric care; and
(b) the patient must require, or be expected
to require in the future, intermediate or long-term psychiatric care.
(iii) The patient must be
medically cleared.
(e)
Who may issue order.
(1) An order of transfer may be issued by the
Commissioner of Mental Health. The commissioner has also delegated this
authority to the Deputy Commissioner for Operations and to the director, or in
the absence of such director to the duly authorized acting director, of any
hospital operated or licensed by the Office of Mental Health. Such order shall
be issued on Form 19 OMH "Order of Transfer," revised and contained in
subdivision (m) of this section. Application for transfer to a hospital whose
director has been delegated the authority to issue orders of transfer pursuant
to this paragraph should be made to that hospital's director.
(2) The Commissioner of the Office of Mental
Health or his/her designee shall have the authority to resolve any disagreement
between the hospital directors regarding the appropriateness of issuing an
order of transfer for a patient.
(f)
Notice of transfer.
Except as provided in paragraph (h)(1) of this section, the
sending hospital shall give three days or more prior written notice of transfer
to the following parties:
(1) the
nearest relative of the patient, other than the applicant for the patient's
transfer;
(2) additional
significant others who the patient has indicated should receive notice of the
patient's hospitalization and status;
(3) the patient's guardian, if any, if such
guardian has not been previously notified and is not included under paragraph
(1) or (2) of this subdivision; and
(4) the Mental Hygiene Legal
Service.
(g)
Process for transfer.
Transfer of a patient should cause the least possible
disruption in the patient's daily living routine. The sending and receiving
hospitals shall cooperate in arranging a process for transfer which
accomplishes this objective. This process may be initiated in the following
ways:
(1) By written application.
(i) The applicant may apply in writing for an
order of transfer, in accordance with this section. Upon issuance of the order,
the applicant and, if necessary, the receiving hospital shall be notified and a
copy of the order and the underlying application shall be forwarded to the
sending hospital, to the Mental Hygiene Legal Service and, if necessary, to the
receiving hospital.
(ii) The
sending hospital shall provide an opportunity to the receiving hospital to
examine the patient prior to admission, unless such examination is waived by
the receiving hospital. The examination may be conducted prior to submission of
the written application for transfer. In the absence of an agreement applicable
to both hospitals which provides for examination of the patient at the
receiving hospital, the receiving hospital shall send a screening team to the
sending hospital to directly interview the patient and meet with members of
staff familiar with the patient. At the time of this screening, the sending
hospital should provide copies of any material described in paragraph (b)(2) of
this section which have not already been provided to the receiving
hospital.
(iii) The patient shall
be transferred as soon as possible to the receiving hospital along with a
certified copy of such patient's admission paper and case record, in accordance
with the order of transfer, unless such hospital determines that the patient is
inappropriate for admission. Copies of any material described in paragraph
(b)(2) of this section which have not already been provided to the receiving
hospital must be provided at this time.
(iv) If the receiving hospital determines
that the patient is not appropriate for admission, the order of transfer shall
not be issued or, if already issued, may be cancelled. The sending facility
shall be immediately notified, the MHLS shall be given immediate written
notice, and the patient, if located at the receiving hospital, shall be
returned to the sending hospital.
(2) By telephone.
(i) As an alternative procedure to paragraph
(1) of this subdivision, the sending hospital may, at the option of the
receiving hospital's director, arrange the transfer with such director or the
designee thereof by telephone. The date of the transfer should be arranged at
that time and confirmed one day prior to the actual transfer.
(ii) A follow-up written application for an
order of transfer which satisfies the requirements of this section shall be
submitted at the time of the patient's examination by the receiving hospital or
at the time of the patient's arrival at the receiving hospital, whichever is
applicable.
(iii) The sending
hospital shall provide an opportunity to the receiving hospital to examine the
patient prior to admission, unless such examination is waived by the receiving
hospital. The examination may be conducted at either the receiving hospital or
the sending hospital, as agreed upon by the two hospitals. At the examination,
the sending hospital should provide copies of any material described in
paragraph (b)(2) of this section.
(iv) If the patient is determined to be
appropriate for admission, an order of transfer shall be issued by the
receiving hospital and a copy forwarded to the sending hospital and the Mental
Hygiene Legal Service. The patient shall be transferred as soon as possible to
the receiving hospital along with a certified copy of such patient's admission
paper and case record, in accordance with the order. Copies of any material
described in paragraph (b)(2) of this section which have not already been
provided to the receiving hospital must be provided at this time.
(v) If the receiving hospital determines that
the patient is not appropriate for admission, an order of transfer shall not be
issued. The sending hospital shall be immediately notified, the MHLS shall be
given immediate written notice, and the patient, if located at the receiving
hospital, shall be returned to the sending hospital.
(h)
Exceptions to process
for transfer.
Where inconsistent with the foregoing provisions of this
section, the following paragraphs shall control:
(1) Expedited transfer of a patient who is
likely to cause immediate serious physical harm. Less than three days' prior
written notice of transfer may be given by the sending hospital to the parties
listed in subdivision (f) of this section if the following conditions are
satisfied:
(i) the patient is at least 18
years of age, or the patient and the patient's parent or guardian both consent
in writing to the transfer;
(ii)
the patient has a mental illness which is likely to result in immediate serious
physical harm to self or others, as defined in section
517.3(g)
of this Part, unless a specified program of services is provided to such
patient; and
(iii) such program of
services is available at the receiving, but not the sending,
hospital.
(2) Transfer
of an involuntary patient whose court hearing on continued retention is
pending.
(i)
(a) The commissioner or a designee thereof
may order the transfer of such patient to a hospital operated by the Office of
Mental Health and such hospital's director shall be substituted for the sending
hospital's director in the hearing if the commissioner or designee determines
that immediate transfer would be in the best interests of the
patient.
(b) If the receiving OMH
hospital is located outside of the county of the sending hospital and a change
of venue to a court located within the county of the receiving hospital would
significantly reduce inconvenience to the patient, the commissioner or designee
shall direct the legal representative for the sending hospital to make
arrangements with the present court for such change of venue.
(ii) If clause
(i)(a) of this paragraph is not applicable, the commissioner
or a designee thereof shall not issue or, if already issued, shall stay an
order of transfer for that patient until completion of the hearing.
(3) Transfer of an involuntary
patient to a residential treatment facility for children and youth. Application
for transfer of such patient to a residential treatment facility for children
and youth shall be reviewed by the pre-admission certification committee
serving such facility in accordance with Part 583 of this Title.
(i)
Notice following
patient's admission to receiving hospital.
(1) The receiving hospital shall give written
notice of the patient's admission, including the date thereof, to the Office of
Mental Health and the Mental Hygiene Legal Service within three days after such
admission. A copy of the admission paper need not accompany such
notice.
(2) The receiving hospital
shall, within three days after the patient is admitted, give written notice of
such admission, including the patient's admission status and rights under
article 9 of the Mental Hygiene Law, to the following parties:
(i) the patient;
(ii) the nearest relative of the patient,
other than the applicant for the patient's transfer;
(iii) additional significant others who the
patient has indicated should receive notice of the patient's hospitalization
and status; and
(iv) the patient's
guardian, if any, if such guardian is not included under subparagraph (ii) or
(iii) of this paragraph.
(j)
Dispute resolution.
Every effort should be made to resolve, in accordance with
local practice not inconsistent with paragraph (e)(2) of this section, any
disputes regarding the refusal to issue or the cancellation of an order of
transfer by a receiving hospital. Transfer of the patient may proceed pending
final resolution of the dispute, unless there is a temporary restraining order
in effect which prohibits such transfer.
(k)
Form A.
Form A
REQUEST FOR ORDER OF TRANSFER
(Date)
I, (Name of Applicant) (Relationship to Patient)
of (Sending Hospital or Address), request the transfer of
(Name of Patient),
to (Receiving Hospital), on (Voluntary or Involuntary)
status.
Such transfer is expected to benefit the patient as
follows:_____________________
____________________________________________________
____________________________________________________
(Please complete ONE of the following
numbered statements)
1. (Name of
Patient) is on Involuntary Status and does not object to being transferred to
(Receiving Hospital). Please issue an Order of Transfer
to............................................................ your
hospital.................................................................
2. (Name of Patient) is on Involuntary Status
and objects to being transferred to (Receiving Hospital). A hearing was held
on__,_________________________________
19 _ in the presence of the above-titled administrator or the
designee thereof. This hearing confirmed our opinion that the patient is in
need of continuing psychiatric hospitalization and would benefit from treatment
at (Receiving Hospital). Please issue
an............................................................
Order of Transfer to your
hospital..........................................................
3. (Name of Patient) is on Voluntary Status
and has consented to this transfer as indicated by the patient's affixed
signature
below...........................................................................
4. (Name of Patient) is under eighteen years
of age and is on Voluntary
Status and was hospitalized on the application of the
patient's parent or legal guardian, who has consented to this transfer as
indicated by such parent's or guardian's signature affixed below.
The following court proceedings involving this patient are
pending: (Please complete if applicable)
Involuntary commitment proceeding, scheduled to be heard in
__Court, located at __, on the _ day of _, 19_, at _ am/pm.
Other proceeding (description of legal proceeding) scheduled
to be heard at
______ Court, located at _______, on the _day of ______, 19_,
at __ am/pm.
(Please check if applicable)
[] No court proceeding involving this patient is
pending.
Signature of Applicant
Signature of Patient or Representative
Telephone approval of Order of Transfer (No. __) given
by
(Name of Receiving Hospital Employee) to
(Name of Sending Hospital Employee) on (Date)
at (Time).
(l)
Form B.
Form B
INFORMATION CHECK LIST
(Date)
We have determined that _________, a patient on Ward _ at
(Sending Hospital), requires continued hospitalization, and is appropriate
for
treatment at (Receiving Hospital). The following material is
appended:
[] Request for Order of Transfer, including summary of the
hearing procedure conducted for any involuntary patient objecting to transfer
(copy to be returned to sending hospital with the signed Order of
Transfer).
[] Summary of the clinical record to date. (This must provide
sufficient detail to allow for assessment of the patient's appropriateness for
hospitalization.)
[] All physical and laboratory examination results pertaining
to the patient's treatment.
[] All legal documents pertaining to the patient's retention
or transfer.
Dr. __________, who can be reached at (Telephone Number), is
the
physician most familiar with the clinical profile of this
patient. In accordance with existing agreements and Part 517 of the Mental
Hygiene regulations, any clinical or discharge summary and any physical and
laboratory examination results not appended hereto and not previously provided
to the receiving hospital shall be made available to such hospital no later
than the time of transfer.
Director of Sending Hospital/Designee
Telephone No.
(m)
Form 19-OMH.
Form 19-OMH
STATE OF NEW YORK OFFICE OF MENTAL HEALTH
ORDER OF TRANSFER
(Pursuant to section 29.11 of the Mental Hygiene Law)
(Date)
A written request to this Office having been made for the
transfer of (Name of Patient),
a patient at (Sending Hospital), and the reasons for such
transfer being satisfactory, and
the Mental Hygiene Legal Service having been given notice of
the proposed transfer, it is hereby ordered that the director of said hospital
discharge said patient for transfer to (Receiving Hospital)
and that the director of the latter hospital receive said
patient for treatment upon the presentation of this original order, together
with a certified copy of the original admission paper and case record.
BY THE COMMISSIONER:
(Signature)
(Print Name)
(Title)
