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The transfer of a patient from one hospital to another, or from a hospital to a nursing home, is a medical decision that must be made by a physician. In this situation, the administrator may be able to argue that the patient's best interest requires a transfer to a different facility. The patient may need more specialized acute care than the hospital can render, or the patient may need the special skills of a chronic care facility. The administrator must be able to persuade the attending physician that the transfer is necessary to avoid injuring the patient. If the attending physician is unwilling to authorize the transfer, it may be necessary to persuade another member of the medical staff to arrange it. The medical section rules and hospital bylaws should have a procedure for such third party review of the need to transfer a patient.

The patient must be consulted about the transfer and informed of the reasons why it is necessary. A written consent should be obtained for the transfer and incorporated in the medical record. If the patient is unwilling to be transferred, legal complications may arise from transferring the patient against the patient's will. When the hospital admits the patient, it implicitly agrees to render care to the patient until the patient can be safely discharged.

As noted earlier in the chapter on hospital liability, there may be situations where the patient poses a danger to others and thus may be transferred, after appropriate legal proceedings, to a more secure facility. The legal basis for transferring patients for their own good, as opposed to the safety of other patients, is not well-established. Since the law does not require all hospitals to offer the same level of technical expertise, there is a legal duty to recommend and facilitate a patient's transfer if this is necessary for the patient's well-being. However, the patient retains the right, after being given proper information, to choose not to be transferred. The hospital should honor the patient's decision to refuse a transfer, but this refusal should be put in writing, including detailed reasons for the request to transfer and the risks of refusing transfer.

The hospital must be careful not to overstate the benefits of a transfer. A common problem involves the transfer to a city or county hospital. It is very common for patients to be told that their care will be free at the county hospital. In most states this is true only if the patient meets both locality and income eligibility requirements. Most transfer patients will not meet these criteria and will be charged for their care, often at private hospital rates. The hospital must also ensure that the proposed facility can actually render the necessary care and that it has room for the patient. The only way to ensure this is to call ahead before transferring the patient.

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