Current through Reg. 49, No. 52; December 27, 2024
(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;
(5) before each patient
transfer, the transferring physician to ensure the receiving general or special
hospital and physician are appropriate to the patient's medical needs and have
accepted responsibility for the patient's medical treatment and hospital care;
and
(6) the LSRH's medical staff
review appropriate records of patients transferred from the LSRH to determine
that the appropriate standard of care has been met.
(r) The LSRH's transfer policy shall comply
with the following requirements related to medical records.
(1) The policy shall require the LSRH to
forward a copy of the portions of the patient's medical record, which are
available and relevant to the transfer and to the continuing care of the
patient, to the receiving physician and receiving hospital with the patient.
When all necessary medical records for the continued care of the patient are
not available at the time the patient is transferred, the transferring LSRH
shall forward the records to the receiving physician and hospital as soon as
possible.
(2) The patient's medical
record shall contain at least the following:
(A) a brief description of the patient's
medical history and physical examination;
(B) a working diagnosis and recorded
observations of physical assessment of the patient's condition at the time of
transfer;
(C) the reason for the
transfer;
(D) the results of all
diagnostic tests, such as laboratory tests;
(E) relevant radiological films and reports;
and
(F) any other relevant
information.
(s) The LSRH's transfer policy shall require
the LSRH to complete a memorandum of transfer for every transferred patient.
(1) The memorandum shall contain the
following information:
(A) if known, the
patient's:
(i) full name;
(ii) race, religion, national origin, age,
sex, disability status;
(iii)
address and phone number; and
(iv)
next of kin address and phone number;
(B) the transferring and receiving
physicians' names, telephone numbers, and addresses;
(C) the transferring LSRH's and receiving
general or special hospital's names, addresses, and telephone
numbers;
(D) the time and date on
which the patient first presented or was presented to the transferring
physician and transferring LSRH;
(E) the time and date on which the
transferring physician secured a receiving physician;
(F) the name of the hospital contact and date
and time hospital administration was contacted in the receiving general or
special hospital;
(G) the
transferring LSRH administrator's signature and title and time the
administrator contacted the receiving hospital;
(H) certification required by subsection
(o)(2) of this section, 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);
(I)
the time and date the receiving physician assumed responsibility for the
patient;
(J) the time and date the
patient arrived at the receiving general or special hospital;
(K) the signature and date of receiving
hospital administration;
(L) the
type of vehicle and company used to transport the patient;
(M) the type of equipment and personnel
needed in transfers;
(N) the name
and city of hospital where the patient was transported;
(O) the patient's diagnosis by the
transferring physician; and
(P) the
attachments by the transferring LSRH.
(2) The transferring LSRH shall retain a copy
of the memorandum of transfer for five years and file the memorandum separately
from the patient's medical record and in a manner facilitating its inspection
by the Texas Health and Human Services Commission.
(t) An LSRH violates HSC Chapter 241 and this
section if:
(1) the LSRH fails to comply with
the requirements of this section; or
(2) the LSRH's governing body fails or
refuses to:
(A) adopt a transfer policy that
complies with this section and contains all requirements listed in this
section;
(B) adopt a memorandum of
transfer form that complies with the content requirements contained in this
section; or
(C) enforce its
transfer policy and the use of the memorandum of transfer.
