<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".06" citation="COMAR 10.05.05.06" title_num="10" subtitle_num="05" chapter_num="05" heading="Surgical Services.">
  <paragraph num="A.">
    <text>Surgical procedures shall be performed in a safe manner by qualified physicians, dentists, or podiatrists who have been granted clinical privileges by the administrator.</text>
  </paragraph>
  <paragraph num="B.">
    <text>The administrator, in consultation with the medical director, shall develop and implement policies, procedures, and protocols for the provision of surgical services including but not limited to:</text>
    <paragraph num="(1)">
      <text>Personnel;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Pre-operative testing and examinations;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Surgical procedures;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Post-anesthesia care and observation;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Discharge planning;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Emergency services;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Informed consent; and</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Safety.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Before conducting a surgical procedure, a physician or other qualified health care practitioner shall conduct a history and physical examination.</text>
  </paragraph>
  <paragraph num="D.">
    <text>If anything other than an unsupplemented local anesthetic is needed to accomplish a surgical procedure, a qualified anesthetist shall conduct a pre-anesthesia evaluation and document the anesthetic risk to the patient.</text>
  </paragraph>
  <paragraph num="E.">
    <text>If the assessments required by §§C and D of this regulation are performed before the day of surgery, a qualified health care practitioner shall on the day of surgery reassess and document any change in the patient's clinical status that could have an effect on the surgical procedure to be performed and the anesthesia to be used.</text>
  </paragraph>
  <paragraph num="F.">
    <text>Discharge.</text>
    <paragraph num="(1)">
      <text>Before discharge from the facility, the anesthetist or, if local anesthesia is administered, the physician, dentist, or podiatrist who performed the surgery shall evaluate each patient for proper anesthesia recovery and document that evaluation.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The physician, dentist, podiatrist, or anesthesiologist shall discharge each patient from the facility to a responsible adult, except those patients for whom no supervision is required as determined by the health care practitioner.</text>
    </paragraph>
  </paragraph>
</regulation>