Texas Administrative Code
Title 26 - HEALTH AND HUMAN SERVICES
Part 1 - HEALTH AND HUMAN SERVICES COMMISSION
Chapter 510 - PRIVATE PSYCHIATRIC HOSPITALS AND CRISIS STABILIZATION UNITS
Subchapter C - OPERATIONAL REQUIREMENTS
Section 510.43 - Patient Transfer Policy
Universal Citation: 26 TX Admin Code ยง 510.43
Current through Reg. 49, No. 38; September 20, 2024
(a) Definitions.
(1) For purposes of this
section, a transferring facility is a private psychiatric hospital licensed
under Health and Safety Code (HSC), Chapter 577.
(2) For purposes of this section, a receiving
facility is one of the following:
(A) a
private psychiatric hospital licensed under HSC, Chapter 577;
(B) a general or special hospital licensed
under HSC, Chapter 241;
(C) a
hospital operated by the Texas Department of Mental Health and Mental
Retardation;
(D) a hospital
operated by a federal agency; or
(E) a chemical dependency treatment facility
licensed under HSC, Chapter 464.
(3) For purposes of this section, patient is
defined as an individual:
(A) seeking
treatment who may or may not be under the immediate supervision of a personal
attending physician, and who, within reasonable medical probability, requires
immediate or continuing services and medical care; or
(B) admitted as a patient.
(b) Applicability.
(1) If a transferring facility or a receiving
facility is licensed under HSC, Chapter 577, it must comply with all
requirements of this section.
(2)
Receiving facilities, other than those licensed under HSC, Chapter 577, are not
governed by these rules.
(c) General.
(1) The governing body of each transferring
facility shall adopt, implement, and enforce a policy relating to patient
transfers that is consistent with this section and contains each of the
requirements in subsection (d) of this section. Facility administration has the
authority to represent a facility during the transfer from or receipt of
patients into the facility.
(2) The
transfer policy shall be adopted by the governing body of the facility after
consultation with the medical staff.
(3) The policy shall govern transfers not
covered by a transfer agreement in accordance with §
510.61 of Title 40 (relating to
Patient Transfer Agreements).
(4)
The movement of a stable patient from a transferring facility to a receiving
facility is not considered to be a transfer under this section if it is the
understanding and intent of both facilities that the patient is going to the
receiving facility only for tests, the patient will not remain overnight at the
receiving facility, and the patient will return to the transferring facility.
This paragraph applies only when a patient remains stable during transport to
and from the facilities and during testing.
(5) The policy shall include a written
operational plan to provide for patient transfer transportation services if the
transferring facility does not provide its own patient transfer transportation
services.
(6) Each governing body,
after consultation with the medical staff, may implement its transfer policy by
adopting transfer agreements with other receiving facilities in accordance with
§
510.61 of Title 40.
(d) Requirements for transfer of patients between facilities.
(1)
Discrimination. Except as is specifically provided in paragraphs (5)(E) and (F)
and (6)(A) and (B) of this subsection, relating, respectively, to mandated
providers and designated providers, the policy shall provide that the transfer
of a patient may not be predicated upon arbitrary, capricious, or unreasonable
discrimination based upon race, religion, national origin, age, sex, physical
condition, or economic status.
(2)
Disclosure. The policy shall recognize the right of an individual to request
transfer into the care of a physician and a receiving facility of his own
choosing; however, if a patient is transferred for economic reasons and the
patient's choice is predicated upon or influenced by representations made by
the transferring physician or transferring facility administration regarding
the availability of medical care and services at a reduced cost or no cost to
the patient, the physician or facility administration shall fully disclose to
the patient the eligibility requirements established by the patient's chosen
physician or receiving facility.
(3) Patient evaluation. The policy shall
provide that each patient who arrives at a transferring facility is evaluated
in accordance with the Texas Department of Mental Health and Mental Retardation
§411.468
of Title 40 (relating to Responding to an Emergency Medical Condition of a
Patient, Prospective Patient, or Individual who Arrives on Hospital Property
Requesting Examination or Treatment).
(A)
After receiving a report on the patient's condition from the nursing staff 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 staff member receiving the order,
and countersigned by the physician authorizing the transfer as soon as
possible. The patient transfers resulting from physician orders issued by
telephone or radio shall be subject to automatic review by the medical staff
pursuant to paragraph (8) of this subsection.
(4) Facility personnel, written protocols,
standing delegation orders, eligibility and payment information. The policy of
the transferring facility and receiving facility shall provide that licensed
nurses and other qualified personnel are available and on duty to assist with
patient transfers and to provide accurate information regarding eligibility and
payment practices. The policy shall provide that written protocols or standing
delegation orders are in place to guide personnel when a patient requires
transfer.
(5) Transfer of patients
who have emergency medical conditions.
(A) If
a patient has an emergency medical condition which has not been stabilized or
when stabilization of the patient's vital signs is not possible because the
transferring facility does not have the appropriate equipment or personnel to
correct the underlying process, evaluation and treatment shall be performed and
transfer shall be carried out as quickly as possible.
(B) The policy shall provide that the
transferring facility may not transfer a patient with an emergency medical
condition which has not been stabilized unless:
(i) the patient or a legally responsible
person acting on the patient's behalf, after being informed of the transferring
facility's obligations under this section and of the risks and benefits of
transfer, requests transfer in writing;
(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 a receiving
facility 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 at the time of transfer, a qualified medical person, as
designated by facility policy, 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
provided by subparagraphs (E) and (F) of this paragraph and paragraph (6)(A)
and (B) of this subsection, the 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.
(D) Except as expressly permitted in clauses
(i) and (ii) of this subparagraph, the policy shall provide for the receipt of
patients who have an emergency medical condition so that upon notification of
and prior to a transfer, the receiving facility shall, after determining
whether or not space, personnel and services necessary to provide appropriate
care for the patient are available, respond to the transferring facility,
within 30 minutes, either accepting or refusing the transfer. The 30-minute
time period begins at the time a member of the staff of the receiving facility
receives the call initiating the request to transfer.
(i) The policy may permit response 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 parties to the transfer. If the transfer is accepted, the
agreed extension shall be documented in the memorandum of transfer.
(E) The policy shall recognize and
comply with the requirements of the Indigent Health Care and Treatment Act,
HSC, §§ 61.030-61.032 and §§ 61.057-61.059 (relating to
Mandated Providers) since those requirements may apply to a patient.
(F) The policy shall acknowledge contractual
obligations and comply with statutory or regulatory obligations which may exist
concerning a patient and a designated provider.
(G) The policy shall require that all
reasonable steps are taken to secure the informed refusal of a patient refusing
a transfer or a related examination and treatment or of a person acting on a
patient's behalf refusing a transfer or a related examination and treatment.
Reasonable steps include:
(i) a factual
explanation of the increased medical risks to the patient reasonably expected
from not being transferred, examined, or treated at the transferring
facility;
(ii) a factual
explanation of any increased risks to the patient from not effecting the
transfer; and
(iii) a factual
explanation of the medical benefits reasonably expected from the provision of
appropriate treatment at a receiving facility.
(H) The informed refusal of a patient, or of
a person acting on a patient's behalf, to examination, evaluation or transfer
shall be documented and signed if possible by the patient or by a person acting
on the patient's behalf, dated and witnessed by the attending physician or
facility employee, and placed in the patient's medical record.
(I) Transfer of patients may occur routinely
or as part of a regionalized plan for obtaining optimal care for patients at a
more appropriate or specialized health care entity.
(6) Transfer of patients who do not have
emergency medical conditions.
(A) The policy
shall recognize and comply with the requirements of the Indigent Health Care
and Treatment Act, HSC, §§ 61.030-61.032 and §§
61.057-61.059 (relating to Mandated Providers) as those requirements may apply
to a patient.
(B) The policy shall
acknowledge contractual obligations and comply with statutory or regulatory
obligations which may exist concerning a patient and a designated
provider.
(C) The policy shall
require that all reasonable steps are taken to secure the informed refusal of a
patient refusing a transfer or a related examination and treatment or of a
person acting on a patient's behalf refusing a transfer or a related
examination and treatment. Reasonable steps include:
(i) a factual explanation of the increased
medical risks to the patient reasonably expected from not being transferred,
examined, or treated at the transferring facility;
(ii) a factual explanation of any increased
risks to the patient from not effecting the transfer; and
(iii) a factual explanation of the medical
benefits reasonably expected from the provision of appropriate treatment at a
receiving facility.
(D)
The informed refusal of a patient, or of a person acting on a patient's behalf,
to examination, evaluation or transfer shall be documented and signed if
possible by the patient or by a person acting on the patient's behalf, dated
and witnessed by the attending physician or facility employee, and placed in
the patient's medical record.
(E)
Transfer of patients may occur routinely or as part of a regionalized plan for
obtaining optimal care for patients at a more appropriate or specialized health
care entity.
(F) The policy shall
recognize the right of an individual to request a transfer into the care of a
physician and a receiving facility of the individual's own choosing.
(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 (3)(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 secure a receiving physician and a
receiving facility that are appropriate to the medical needs of the patient and
that will accept responsibility for the patient's medical treatment and
care.
(8) Record review
for standard of care. The policy shall provide that the medical staff review
appropriate records of patients transferred to determine that the appropriate
standard of care has been met.
(9)
Medical record.
(A) The 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 facility 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 receiving facility 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 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 facilities;
(vi) the time and date on which the patient
first presented or was presented to the transferring physician and transferring
facility;
(vii) the time and date
on which the transferring physician secured a receiving physician;
(viii) the name, date, and time
administration was contacted in the receiving facility;
(ix) signature, time, and title of the
transferring facility administration who contacted the receiving
facility;
(x) the certification
required by paragraph (5)(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 facility;
(xiii) signature and date of receiving
administration;
(xiv) type of
vehicle and company used;
(xv) type
of equipment and personnel needed in transfers;
(xvi) name and city of facility to which
patient was transported;
(xvii)
diagnosis by transferring physician; and
(xviii) attachments by transferring
facility.
(C) A copy of
the memorandum of transfer shall be retained by the transferring and receiving
facilities. The memorandum shall be filed separately from the patient's medical
record and in a manner which will facilitate its inspection by the department.
All memorandum of transfer forms filed separately shall be retained for five
years.
(e) Violations. A facility violates HSC, Chapter 577 and this section if:
(1) the facility fails to comply with the
requirements of this section; or
(2) the governing body fails or refuses to:
(A) adopt a transfer policy which is
consistent with this section and contains each of the requirements in
subsection (d) of this section;
(B)
adopt a memorandum of transfer form which meets the minimum requirements for
content contained in this section; or
(C) enforce its transfer policy and the use
of the memorandum of transfer.
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