2006 Code of Virginia § 32.1-127 - Regulations

32.1-127. Regulations.

A. The regulations promulgated by the Board to carry out the provisions ofthis article shall be in substantial conformity to the standards of health,hygiene, sanitation, construction and safety as established and recognized bymedical and health care professionals and by specialists in matters of publichealth and safety, including health and safety standards established underprovisions of Title XVIII and Title XIX of the Social Security Act, and tothe provisions of Article 2 ( 32.1-138 et seq.) of this chapter.

B. Such regulations:

1. Shall include minimum standards for (i) the construction and maintenanceof hospitals, nursing homes and certified nursing facilities to assure theenvironmental protection and the life safety of its patients and employeesand the public; (ii) the operation, staffing and equipping of hospitals,nursing homes and certified nursing facilities; (iii) qualifications andtraining of staff of hospitals, nursing homes and certified nursingfacilities, except those professionals licensed or certified by theDepartment of Health Professions; and (iv) conditions under which a hospitalor nursing home may provide medical and nursing services to patients in theirplaces of residence;

2. Shall provide that at least one physician who is licensed to practicemedicine in this Commonwealth shall be on call at all times, though notnecessarily physically present on the premises, at each hospital whichoperates or holds itself out as operating an emergency service;

3. May classify hospitals and nursing homes by type of specialty or serviceand may provide for licensing hospitals and nursing homes by bed capacity andby type of specialty or service;

4. Shall also require that each hospital establish a protocol for organdonation, in compliance with federal law and the regulations of the Centersfor Medicare & Medicaid Services (CMS), particularly 42 C.F.R. 482.45. Eachhospital shall have an agreement with an organ procurement organizationdesignated in CMS regulations for routine contact, whereby the provider'sdesignated organ procurement organization certified by CMS (i) is notified ina timely manner of all deaths or imminent deaths of patients in the hospitaland (ii) is authorized to determine the suitability of the decedent orpatient for organ donation and, in the absence of a similar arrangement withany eye bank or tissue bank in Virginia certified by the Eye Bank Associationof America or the American Association of Tissue Banks, the suitability fortissue and eye donation. The hospital shall also have an agreement with atleast one tissue bank and at least one eye bank to cooperate in theretrieval, processing, preservation, storage, and distribution of tissues andeyes to ensure that all usable tissues and eyes are obtained from potentialdonors and to avoid interference with organ procurement. The protocol shallensure that the hospital collaborates with the designated organ procurementorganization to inform the family of each potential donor of the option todonate organs, tissues, or eyes or to decline to donate. The individualmaking contact with the family shall have completed a course in themethodology for approaching potential donor families and requesting organ ortissue donation that (i) is offered or approved by the organ procurementorganization and designed in conjunction with the tissue and eye bankcommunity and (ii) encourages discretion and sensitivity according to thespecific circumstances, views, and beliefs of the relevant family. Inaddition, the hospital shall work cooperatively with the designated organprocurement organization in educating the staff responsible for contactingthe organ procurement organization's personnel on donation issues, the properreview of death records to improve identification of potential donors, andthe proper procedures for maintaining potential donors while necessarytesting and placement of potential donated organs, tissues, and eyes takesplace. This process shall be followed, without exception, unless the familyof the relevant decedent or patient has expressed opposition to organdonation, the chief administrative officer of the hospital or his designeeknows of such opposition, and no donor card or other relevant document, suchas an advance directive, can be found;

5. Shall require that each hospital that provides obstetrical servicesestablish a protocol for admission or transfer of any pregnant woman whopresents herself while in labor;

6. Shall also require that each licensed hospital develop and implement aprotocol requiring written discharge plans for identified, substance-abusing,postpartum women and their infants. The protocol shall require that thedischarge plan be discussed with the patient and that appropriate referralsfor the mother and the infant be made and documented. Appropriate referralsmay include, but need not be limited to, treatment services, comprehensiveearly intervention services for infants and toddlers with disabilities andtheir families pursuant to Part H of the Individuals with DisabilitiesEducation Act, 20 U.S.C. 1471 et seq., and family-oriented preventionservices. The discharge planning process shall involve, to the extentpossible, the father of the infant and any members of the patient's extendedfamily who may participate in the follow-up care for the mother and theinfant. Immediately upon identification, pursuant to 54.1-2403.1, of anysubstance-abusing, postpartum woman, the hospital shall notify, subject tofederal law restrictions, the community services board of the jurisdiction inwhich the woman resides to appoint a discharge plan manager. The communityservices board shall implement and manage the discharge plan;

7. Shall require that each nursing home and certified nursing facility fullydisclose to the applicant for admission the home's or facility's admissionspolicies, including any preferences given;

8. Shall require that each licensed hospital establish a protocol relating tothe rights and responsibilities of patients which shall include a processreasonably designed to inform patients of such rights and responsibilities.Such rights and responsibilities of patients, a copy of which shall be givento patients on admission, shall be based on Joint Commission on Accreditationof Healthcare Organizations' standards;

9. Shall establish standards and maintain a process for designation of levelsor categories of care in neonatal services according to an applicablenational or state-developed evaluation system. Such standards may bedifferentiated for various levels or categories of care and may include, butneed not be limited to, requirements for staffing credentials, staff/patientratios, equipment, and medical protocols;

10. Shall require that each nursing home and certified nursing facility trainall employees who are mandated to report adult abuse, neglect, orexploitation pursuant to 63.2-1606 on such reporting procedures and theconsequences for failing to make a required report;

11. Shall permit hospital personnel, as designated in medical staff bylaws,rules and regulations, or hospital policies and procedures, to acceptemergency telephone and other verbal orders for medication or treatment forhospital patients from physicians, and other persons lawfully authorized bystate statute to give patient orders, subject to a requirement that suchverbal order be signed, within a reasonable period of time not to exceed 72hours as specified in the hospital's medical staff bylaws, rules andregulations or hospital policies and procedures, by the person giving theorder, or, when such person is not available within the period of timespecified, co-signed by another physician or other person authorized to givethe order; and

12. Shall require, unless the vaccination is medically contraindicated or theresident declines the offer of the vaccination, that each certified nursingfacility and nursing home provide or arrange for the administration to itsresidents of (i) an annual vaccination against influenza and (ii) apneumococcal vaccination, in accordance with the most recent recommendationsof the Advisory Committee on Immunization Practices of the Centers forDisease Control and Prevention.

C. Upon obtaining the appropriate license, if applicable, licensed hospitals,nursing homes, and certified nursing facilities may operate adult day carecenters.

D. All facilities licensed by the Board pursuant to this article whichprovide treatment or care for hemophiliacs and, in the course of suchtreatment, stock clotting factors, shall maintain records of all lot numbersor other unique identifiers for such clotting factors in order that, in theevent the lot is found to be contaminated with an infectious agent, thosehemophiliacs who have received units of this contaminated clotting factor maybe apprised of this contamination. Facilities which have identified a lotwhich is known to be contaminated shall notify the recipient's attendingphysician and request that he notify the recipient of the contamination. Ifthe physician is unavailable, the facility shall notify by mail, returnreceipt requested, each recipient who received treatment from a knowncontaminated lot at the individual's last known address.

(Code 1950, 32-301; 1972, c. 36; 1979, c. 711; 1985, c. 335; 1986, c. 135;1987, c. 224; 1988, cc. 325, 418; 1989, cc. 434, 618, 699; 1992, cc. 334,428; 1993, c. 335; 1996, cc. 361, 411; 1997, c. 454; 1998, c. 450; 2000, cc.176, 810; 2001, c. 463; 2004, c. 762.)