Transfer and Transport of Patients

(1) 104 CMR 27.08 governs the transfer of patients pursuant to M.G.L. c. 123, § 3 and the transport of patients pursuant to M.G.L. c. 123, § 21. (2) For the purposes of 104 CMR 27.08(3) through (8), “emergency” shall mean those medical, surgical and psychiatric crises which, in the opinion of the facility director, threaten the safety, health or life of the patient or others, and which could not be appropriately treated in the transferring facility. (3) Permitted Transfers; Exceptions. Any patient admitted to a facility may be transferred from that facility to any other facility, provided that except in an emergency: (a) Patients on voluntary status under 104 CMR 27.06 shall not be subject to transfer without their written consent; and (b) Patients on conditional voluntary status under 104 CMR 27.06 may refuse transfer. Such refusal may be considered equivalent to submission of the patient’s three-day written notice of his or her intention to leave or withdraw from the facility. Upon such refusal, the facility director may file a petition for commitment under the provisions of M.G.L. c. 123, §§ 7 and 8 if the patient meets the criteria for commitment, or may withdraw the notice of transfer provided to the patient pursuant to 104 CMR 27.08(9). (4) Absent an emergency, a patient 16 years of age or older on conditional voluntary status at a facility may not be transferred from that facility over his or her objection, or in the case of a minor, or a patient admitted by health care agent pursuant to a properly invoked and affirmed health care proxy, over the objection of such minor or patient’s legally authorized representative, unless a court of competent jurisdiction enters a commitment order pursuant to M.G.L. c. 123, §§ 7 and 8. (5) Absent an emergency, a patient younger than 16 years old who has been admitted to a facility pursuant to his or her legally authorized representative’s authority, may not be transferred from that facility over the objection of the legally authorized representative, unless a court of competent jurisdiction enters a commitment order pursuant to M.G.L. c. 123, §§ 7 and 8. (6) In no event shall an application for admission pursuant to M.G.L. c. 123, § 12(a) be issued in order to transfer a patient in lieu of compliance with the requirements of M.G.L. c. 123, § 3, and 104 CMR 27.08. (7) Patients transferred pursuant to M.G.L. c. 123, § 3, and 104 CMR 27.08 shall be admitted to the receiving facility under the same legal status pursuant to which the patient was hospitalized at the transferring facility. Transfer of a patient committed pursuant to M.G.L. c. 123 shall not extend the period of such commitment. (8) A patient who is admitted or committed to a facility licensed pursuant to 104 CMR 27.00, who is transferred to a medical facility for treatment of a medical condition during the period of his or her admission or commitment, may be readmitted to the transferring facility under the same legal status pursuant to which the patient was admitted or committed to the transferring facility; provided however, that for a patient who is committed pursuant to a court order, such court order has not expired at the time of readmission. (9) Transfer Procedures. (a) The approval of the director of the receiving facility shall be obtained by the transferring facility. (b) The director of the transferring facility shall give six days written notice to the patient to be transferred and, if applicable, to his or her legally authorized representative; provided however, that if such transfer must be made immediately because of an emergency, notice shall be given within 24 hours after the transfer pursuant to M.G.L. c. 123, § 3. The notice, which shall include the patient or legally authorized representative’s right to object as provided in 104 CMR 27.08(4) and (5), shall be provided in a form prescribed by the Department. (c) The director shall inform the patient that notice of transfer shall also be given to his or her nearest relative; unless the patient knowingly objects. (d) A patient or a legally authorized representative with authority to admit the patient to a psychiatric facility may waive the six days notice requirement. (e) A copy of the notice of transfer, along with a copy of the patient’s underlying admission status documentation, shall accompany the patient to the receiving facility. (10) Transport of Patients Admitted to a Facility; Limitations of Use of Restraint. (a) The transport of a patient in a facility may be authorized by the facility director, or designee, on a form approved by the Department, for the following purposes: 1. Transfer to another facility pursuant to M.G.L. c. 123, § 3; 2. Movement among separate campuses of a single facility; 3. Evaluation and/or treatment at a medical facility or office and return to the facility; 4. Attendance at court proceedings and return to the facility; 5. Transfer to or from another state pursuant to the Interstate Compact on Mental Health, M.G.L. c. 123, App. §§ 1-1 through 1-4; and 6. Other destinations with the approval of the facility director or designee. (b) Restraint of a patient in a facility by or under the supervision of the facility’s staff may not be used in the course of transport, unless such restraint is necessary for the safety of the patient being transported or of others who are likely to come into contact with the patient being transported. Such restraint must be by the least restrictive method to assure the safety of the patient or others in accordance with 104 CMR 27.08(10). Such restraint must be authorized by a clinician authorized to order restraint pursuant to 104 CMR 27.12(8)(a)1., or in an emergency when an authorized clinician is not available, by a staff person authorized to initiate restraint pursuant to 104 CMR 27.12(8)(a)2. 1. If the patient is being transported by the facility, or under the supervision of the facility’s staff, then the clinician's authorization shall describe the circumstances under which restraint may be used in the course of transport and method of restraint that may be employed. a. No locked mechanical restraint devices requiring the use of a key for their release may be used in the course of transport. b. Only restraint procedures or devices that have been approved by the facility for such purposes may be used for restraint during transport, and monitoring staff must have received appropriate training on such approved procedures and devices. c. No patient shall be placed in restraints in the course of transport, unless a staff member is assigned to provide one-to-one monitoring as provided in 104 CMR 27.12(8)(h)1. through 6. d. During the transport, the monitoring staff person must carry a copy of the form which authorizes the restraint during transport. e. The driver of the vehicle in which the patient is being transported may not be assigned to provide such monitoring. f. No staff member who has not been trained in accordance with 104 CMR 27.12(3) may be authorized to apply restraints to a patient in the course of transport, or to monitor a patient who is in restraints in the course of transport. g. Except as provided in 104 CMR 27.08(10)(c) and (d), restraint ordered pursuant to 104 CMR 27.08(10) may only last while the patient is under the supervision of facility staff, and shall terminate if the patient is admitted to a medical facility, including the emergency department of such medical facility for evaluation or treatment. (c) If the patient is being transported by ambulance, then restraint may be used only in accordance with M.G.L. c. 111C, § 18. (d) Nothing in 104 CMR 27.08(10) shall be deemed to regulate the use of restraint by licensed law enforcement personnel in the transport of patients in the custody of such personnel. (e) The use of seatbelts or a “child safety door lock” shall not be considered restraint for purposes of 104 CMR 27.08(10). (f) Where the need for restraint during transport for purposes described in 104 CMR 27.08(10)(a) is anticipated, consideration should be given to delaying such transport until such patient no longer requires restraint, if such delay is reasonable. (g) Unless the patient is fully discharged prior to transport, a patient transported pursuant to 104 CMR 27.08(10) shall remain on the admission status under which the patient was admitted to the facility, until such time as the patient is fully discharged from the facility; provided however, that an order of transport pursuant to 104 CMR 27.08(10) shall not extend any relevant time period including, but not limited to, expiration of a commitment order, for such admission.