<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".23" citation="COMAR 10.07.01.23" title_num="10" subtitle_num="07" chapter_num="01" heading="Guidelines Governing the Transfer of Patients Between Hospitals.">
  <paragraph num="A.">
    <text>If a hospital is able to provide adequate care to a patient, the hospital may not transfer the patient to another hospital unless:</text>
    <paragraph num="(1)">
      <text>One or more of the following circumstances is present:</text>
      <paragraph num="(a)">
        <text>The patient does not have a physician with privileges at the hospital and the patient refuses treatment by any physician with privileges at the hospital;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The patient or a legally authorized representative of the patient requests the transfer;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The transfer is in compliance with relevant sections of Health-General Article, Title 10, Subtitle 8, Annotated Code of Maryland;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>The transfer is in compliance with the Interstate Compact on Mental Health as adopted in Health-General Article, Title 11, Annotated Code of Maryland; or</text>
      </paragraph>
      <paragraph num="(e)">
        <text>The transfer is in compliance with any agreement entered into between the Department and a hospital for the provision of acute inpatient psychiatric care in State hospital conversion beds;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>These circumstances are documented in the patient's medical record; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The provisions of this regulation are met.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>A hospital may not use the inability of a patient to pay or the source of payment for a patient as a reason to transfer the patient to another hospital.</text>
  </paragraph>
  <paragraph num="C.">
    <text>Before moving a patient, the transferring hospital shall:</text>
    <paragraph num="(1)">
      <text>Determine that the patient can be transferred without causing harm to the patient;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Notify the receiving hospital of the transfer; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Unless otherwise provided for in an agreement with the Department for State hospital conversion beds, obtain from the receiving hospital confirmation that:</text>
      <paragraph num="(a)">
        <text>The receiving hospital consents to accept the patient; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The patient meets any criteria that the receiving hospital has established for admission regarding:</text>
        <paragraph num="(i)">
          <text>The patient's required level of care;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Physician services available; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Other services necessary to treat the patient.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Explanation of Transfer.</text>
    <paragraph num="(1)">
      <text>Except as otherwise provided in §C(2),, of this regulation, before moving a patient, the transferring hospital shall provide explanation of the reasons for the transfer and any alternative to the transfer to the patient or to a legally authorized representative of the patient.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>If the transferring hospital can document that the necessity to move the patient to the receiving hospital is immediate to protect the health, safety, or welfare of the patient, the transferring hospital may give the explanation required in §C(1), of this regulation, concurrently with the transfer.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>In effecting a transfer, the transferring hospital shall provide that:</text>
    <paragraph num="(1)">
      <text>Medically appropriate life-support measures that a reasonable and prudent physician exercising ordinary care would use are used to stabilize the patient before transfer and sustain the patient during transfer;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Appropriate personnel and equipment that a reasonable and prudent physician exercising ordinary care would use are provided and used in the transfer; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>All records necessary for continuing the patient's care are transferred with the patient.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>The Department shall inspect hospitals for compliance with this regulation as provided in Regulations .07 and .08 of this chapter.</text>
  </paragraph>
  <paragraph num="G.">
    <text>Penalties.</text>
    <paragraph num="(1)">
      <text>The Secretary may impose a penalty not exceeding $1,000 per violation on any hospital that violates this regulation.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>In determining the amount of the penalty, the Secretary shall consider:</text>
      <paragraph num="(a)">
        <text>The hospital's history of previous violations;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The seriousness of the violation;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Whether the hospital demonstrated good faith in attempting to comply with this regulation; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Whether the violation threatened the health or safety of:</text>
        <paragraph num="(i)">
          <text>A patient; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>The public.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </paragraph>
</regulation>