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Regulations Related to Providing Certain Health Care Services
Re: Transfers from Emergency Room |
Q: I am a FNP working in an emergency room in a small rural Texas hospital. A physician is on call, but usually not onsite when I staff the ER. If a patient presents to the ER that needs immediate transfer to a larger hospital, the on-call physician does not always see that patient before transfer. The receiving hospital always insists that a physician’s name appear on the transfer document. Is this really required by law?
A: Yes, Texas law requires that a physician be involved in both ends of the transfer of a patient from one hospital system to another.
This is an example of state law being more restrictive than federal law. EMTALA does not require a physician to be involved in all transfers, but §241.027(b), Texas Health & Safety Code, refers to “medically appropriate transfers from physician to physician.” You and the hospital are required to follow that more restrictive requirement.
Hospital Licensing Rules do not require the physician to actually see the patient if that would delay the transfer and endanger the patient. However, you must call the physician and discuss the patient’s case with the physician at the first opportunity. Even in hospitals with existing transfer agreements, that physician will have to sign the transfer document (even if that signature is obtained after the fact). You will sign the document as the health care professional that saw the patient and executed the transfer. |
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© 2006 Coalition for Nurses in Advance Practice
P.O. Box 5047; Austin • Texas 78763-5047 • 512-469-7882
www.cnaptexas.org
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