HAR §11-95-1. Purpose

The purpose of this chapter is to establish minimum requirements for the protection of the health, welfare, and safety of patients, personnel, and the public in freestanding surgical outpatient facilities. This chapter shall not be construed as lowering standards, ordinances, or rules established by other agencies of government. In all instances the more stringent rules shall apply. [Eff March 3, 1986] (Auth: HRS §§321-9, 321-10, 321-11) (Imp: HRS §§321-10, 321-11) §11-95-2 Definitions as used in this chapter: "Administrator" is the person to whom is delegated the responsibility for the interpretation and implementation of the policies and programs established by the governing body. This person may or may not be the same as the medical director. The administrator shall have had suitable and sufficient previous experience in administration of a medical facility. "Anesthesia assistant" means a person who has successfully completed a four year educational program for physicians' assistants that includes two years of specialized academic and clinical training in anesthesia. "Anesthesiologist" means a physician whose specialized training and experience qualify the physician to administer anesthetic agents and to monitor the patient under the influence of these agents. "Anesthetist" means a certified registered nurse anesthetist. "Broad service hospital" means a medical facility which is staffed and equipped to provide inpatient medical and surgical care for acute illness, injury, and obstetrics over a period of time longer than twenty-four hours. "Cardiopulmonary resuscitation" or "CPR" means an emergency first aid procedure that consists of opening and maintaining a patient's airway, providing artificial ventilation by means of rescue breathing, and providing artificial circulation by means of external cardiac compression. "Chest x-ray" means a full-sized 11" x 14" film taken by the standard technique. "Dentist" means any person having a valid, unrevoked, license issued by the State of Hawaii to practice "dentistry" as defined by chapter 448, HRS. "Department" means the department of health of the State of Hawaii. "Dietitian" means a person who: (1) Is registered by the American Dietetic Association; or (2) Is eligible for examination to become a registered dietitian. "Director" means the director of health of the State of Hawaii. "Freestanding surgical outpatient facility" is a facility developed for the purpose of performing surgical procedures which do not require hospitalization. The procedures are referred to as permitted procedures. Patients admitted to the facility shall remain only long enough to satisfy the objective of the facility and in no case shall they remain longer than eighteen hours. The facility shall provide for continuous physician's services and for continuous registered professional nursing services, on the premises, whenever a patient is in the facility. It shall have an organized administrative structure. The facility shall not be an integral part of a broad service hospital and shall not include the offices of private physicians, dentists, or podiatrists. if the facility is located in the same building with a broad service hospital or with physician's offices, the freestanding surgical outpatient facility shall be a "distinct part", separate from the other medical facilities. A "distinct part" shall be an entire, physically identifiable unit with its own staff, own records, and own equipment. There shall not be any question as to the distinctness of the freestanding surgical outpatient facility from the other medical facilities and services in the same building. "Governing body" means the individual, individual agency, group, or corporation which has the ultimate responsibility and authority for the conduct of the freestanding surgical outpatient facility and is named in the license as the governing body. "Licensee" means the governing body to whom the license is issued. "Licensed practical nurse" means a nurse licensed as such by the State of Hawaii, as defined by chapter 457, HRS. "Local hospital" means a licensed hospital on the same island as the freestanding surgical outpatient facility. "Medical director" is the physician who is responsible for planning, organizing, conducting and directing the medical affairs of the facility. The medical director shall currently hold active surgical or anesthesiologist privileges at a local hospital. "Medical staff" are physicians and dentists authorized by the governing body to practice their profession within the facility. "Operating room" is a room specifically set aside in which surgical procedures only are performed. "Outpatient" is a person seeking treatment from the freestanding surgical outpatient facility and who does not stay overnight in the facility. "Pathologist" means a physician certified or eligible to be certified by the American Board of Pathology. "Patient" means a person admitted to and receiving care in a freestanding surgical outpatient facility. "Permitted procedures" are those which: (1) Are commonly performed on an inpatient basis in hospitals but may be safely performed in a freestanding surgical outpatient facility; (2) Are not of a type that are commonly or safely performed in physicians' offices. (3) Are limited to those requiring a dedicated operating room, or suite, and generally requiring a post-operative recovery room or short term convalescent room; (4) Do not generally result in extensive blood loss; (5) Do not generally require major or prolonged invasion of body cavities; (6) Do not generally involve major blood vessels; (7) Are not generally of an emergency or life threatening nature; (8) Do not include procedures where the surgical operating time plus the post-anesthetic recovery time would normally exceed the planned business hours of the facility. "Pharmacist" means a "registered pharmacist" as defined by chapter 461, HRS. "Physician" means a person having in the State of Hawaii a valid license to practice medicine pursuant to chapters 453 or 460, HRS. "Post-anesthetic recovery time" means that period of time which ends when: (1) The patient is alert and oriented and has reached pre-operative mental status; and (2) The patient's vital signs have returned to be within normal physiological limits; and (3) The patient is able to ambulate without dizziness and has regained pre-operative ambulation ability; and (4) The patient is not nauseated or vomiting and can retain fluids by mouth. "Recovery area" refers to a specific room or space used for post-anesthetic recovery of surgical patients. "Registered professional nurse" means a person who is licensed as a "registered nurse" in the State of Hawaii, as defined by chapter 457, HRS. "Tuberculin test" means an intradermal injection of .0001 mg (5 tuberculin units) of purified protein derivative in 0.1 cc of sterile diluent. If the size of any resulting palpable induration at forty-eight hours and seventy-two hours after injection is equal to or greater than 10 mm in its transverse diameter, the reaction to the skin test shall be considered positive. [Eff March 3, 1986] (Auth: HRS §§321-9, 321-10) (Imp: HRS §§26-13, 321-1, 321-10)