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Definition of Transfer

The law speaks in terms of transferring patients, but it uses an unusual definition of transfer that also includes discharging the patient or just turning the patient away:

The term "transfer" means the movement (including the discharge) of an individual outside a hospital's facilities at the direction of any person employed by (or affiliated or associated, directly or indirectly, with) the hospital, but does not include such a movement of an individual who (A) has been declared dead, or (B) leaves the facility without the permission of any such person.

If a patient is transferred--sent from the emergency room in any fashion without having been stabilized--the emergency room personnel must satisfy the statutory requirements for a proper transfer:

An appropriate transfer to a medical facility is a transfer--

in which the transferring hospital provides the medical treatment within its capacity which minimizes the risks to the individual's health and, in the case of a woman in labor, the health of the unborn child;

in which the receiving facility--

has available space and qualified personnel for the treatment of the individual, and

has agreed to accept transfer of the individual and to provide appropriate medical treatment.

The act requires that the patient be accompanied with all available medical information and the documents establishing compliance with the act. Requiring the inclusion of these records, including the name of any physicians who do not comply with the act, ensures that they will be incorporated in the patient's medical record. This makes them available to federal inspectors and to interested plaintiffs' attorneys:

The transferring hospital sends to the receiving facility all medical records (or copies thereof), related to the emergency condition for which the individual has presented, available at the time of the transfer, including records related to the individual's emergency medical condition, observations of signs or symptoms, preliminary diagnosis, treatment provided, results of any tests and the informed written consent [requesting transfer] or certification [of the medical necessity of transfer] and the name and address of any on-call physician ... who has refused or failed to appear within a reasonable time to provide necessary stabilizing treatment.

It is critical that these materials establish the medical facts to support the medical necessity of the transfer. In the case upholding a $20,000 fine against a physician who violated the act, the court stressed the importance of documenting the medical basis of the transfer.[219]

[219]Burditt v. United States Dept. of Health and Human Services. 934 F2d 1362 (5th Cir, Jul 9, 1991).

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