Definitions

(1) Abuse. The willful infliction of injury, unreasonable confinement, intimidation or punishment with resulting physical harm, pain or mental anguish. (2) Acceptable Plan of Correction. The Licensing Division shall approve a hospital’s acceptable plan to correct deficiencies identified during an on-site survey conducted by the Survey Division or its designated representative. The plan of correction shall be a written document and shall provide, but not limited to, the following information: (a) How the deficiency will be corrected. (b) Who will be responsible for correcting the deficiency. (c) The date the deficiency will be corrected. (d) How the facility will prevent the same deficiency from re-occurring. (3) Adult. An individual who has capacity and is at least 18 years of age. (4) Advance Directive. An individual instruction or a written statement relating to the subsequent provision of health care for the individual, including, but not limited to, a living will or a durable power of attorney for health care. (5) Agent. An individual designated in an advance directive for health care to make a health care decision for the individual granting the power. (6) Board. The Tennessee Board for Licensing Health Care Facilities. (7) Capacity. An individual’s ability to understand the significant benefits, risks, and alternatives to proposed health care and to make and communicate a health care decision. These regulations do not affect the right of a patient to make health care decisions while having the capacity to do so. A patient shall be presumed to have capacity to make a health care decision, to give or revoke an advance directive, and to designate or disqualify a surrogate. Any person who challenges the capacity of a patient shall have the burden of proving lack of capacity. (8) Cardiopulmonary Resuscitation (CPR). The administering of any means or device to support cardiopulmonary functions in a patient, whether by mechanical devices, chest compressions, STANDARDS FOR HOSPITALS CHAPTER 0720-14 mouth-to-mouth resuscitation, cardiac massage, tracheal intubation, manual or mechanical ventilators or respirations, defibrillation, the administration of drugs and/or chemical agents intended to restore cardiac and/or respiratory functions in a patient where cardiac or respiratory arrest has occurred or is believed to be imminent. (9) Certified Master Social Worker. A person currently certified as such by the Tennessee Board of Social Worker Certification and Licensure. (10) Certified Nurse Practitioner. A person who is licensed as a registered nurse and has further been issued a certificate of fitness to prescribe and/or issue legend drugs by the Tennessee Board of Nursing. (11) Certified Registered Nurse Anesthetist. A registered nurse currently licensed by the Tennessee Board of Nursing who is currently certified as such by the American Association of Nurse Anesthetists. (12) Certified Respiratory Therapist. A person currently certified as such by the Tennessee Board of Medical Examiners’ Council on Respiratory Care. (13) Certified Respiratory Therapy Technician. A person currently certified as such by the Tennessee Board of Medical Examiners’ Council on Respiratory Care. (14) Clinical Laboratory Improvement Act (CLIA). The federal law requiring that clinical laboratories be approved by the U.S. Department of Health and Human Services, Health Care Financing Administration. (15) Collaborative Practice. The implementation of the collaborative plan that outlines procedures for consultation and collaboration with other health care professionals, e.g., licensed physicians and mid-level practitioners. (16) Collaborative Plan. The formal written plan between the mid-level practitioners and a licensed physician. (17) Commissioner. The Commissioner of the Tennessee Department of Health or his or her authorized representative. (18) Competent. A patient who has capacity. (19) Critical Access Hospital. A hospital located in a rural area, designated by the Center for Medicare and Medicaid Services (CMS), which makes available twenty-four (24) hour emergency care; is a designated provider in a rural health network; provides not more than twenty-five (25) acute care inpatient beds for providing inpatient care not to exceed an annual average of ninety-six (96) hours, and has a quality assessment and performance improvement program and procedures for utilization review. If swing-bed approval has been granted, all twenty-five (25) beds can be used interchangeably for acute or Skilled Nursing Facility (SNF/swing-bed) level of care services. (20) Dentist. A person currently licensed as such by the Tennessee Board of Dentistry. (21) Department. The Tennessee Department of Health. (22) Designated Physician. A physician designated by an individual or the individual’s agent, guardian, or surrogate, to have primary responsibility for the individual’s health care or, in the absence of a designation or if the designated physician is not reasonably available, a physician who undertakes such responsibility. STANDARDS FOR HOSPITALS CHAPTER 0720-14 (23) Designation. An official finding and recognition by the Commission that an acute care hospital meets the requirements to be designated by CMS as a Critical Access Hospital, Rural Emergency Hospital, or a hospital deemed as a necessary provider prior to January 1, 2006. (24) Dietitian. As used in the chapter, the term “dietitian” means: (a) A person who is currently licensed by the Tennessee Board of Dietitian/Nutritionist Examiners as a dietitian/nutritionist; or (b) An employee of a Tennessee hospital who is exempt from Tennessee licensure pursuant to T.C.A. § 63-25-104(b)(6) but holds the credential of Registered Dietitian (RD) or Registered Dietitian Nutritionist (RDN) from the Commission on Dietetic Registration. (25) Do-Not-Resuscitate Order (DNR). A written order, other than a POST, not to resuscitate a patient in cardiac or respiratory arrest in accordance with accepted medical practices. (26) Dual Licensure Designation. A hospital may be designated as a dual licensed facility with the Commission and the Department of Mental Health and Substance Abuse Services. Such a designation will be indicated on the license. A dual licensed facility must meet all plans review requirements under Tenn. Comp. R. and Regs. 0720-43-.01, et seq. (27) Electronic Signature. The authentication of a health record document or documentation in an electronic form achieved through electronic entry of an exclusively assigned, unique identification code entered by the author of the documentation. (28) Emancipated Minor. Any minor who is or has been married or has by court order or otherwise been freed from the care, custody and control of the minor’s parents. (29) Emergency Responder. A paid or volunteer firefighter, law enforcement officer, or other public safety official or volunteer acting within the scope of his or her proper function under law or rendering emergency care at the scene of an emergency. (30) Graduate Registered Nurse Anesthetist. A registered nurse currently licensed in Tennessee who is a graduate of a nurse anesthesia educational program that is accredited by the American Association of Nurse Anesthetist’s Council on Accreditation of Nurse Anesthesia Educational Programs and awaiting initial certification examination results, provided that initial certification is accomplished within eighteen (18) months of completion of an accredited nurse anesthesia educational program. (31) Guardian. A judicially appointed guardian or conservator having authority to make a health care decision for an individual. (32) Hazardous Waste. Materials whose handling, use, storage, and disposal are governed by local, state or federal regulations. (33) Health Care. Any care, treatment, service or procedure to maintain, diagnose, treat, or otherwise affect an individual’s physical or mental condition, and includes medical care as defined in T.C.A. § 32-11-103(5). (34) Health Care Decision. Consent, refusal of consent or withdrawal of consent to health care. (35) Health Care Decision-Maker. In the case of a patient who lacks capacity, the patient’s health care decision-maker is one of the following: the patient’s health care agent as specified in an advance directive, the patient’s court-appointed guardian or conservator with health care decision-making authority, the patient’s surrogate as determined pursuant to Rule 0720-14- STANDARDS FOR HOSPITALS CHAPTER 0720-14 .13 or T.C.A. § 33-3-220, the designated physician pursuant to these rules or in the case of a minor child, the person having custody or legal guardianship. (36) Health Care Institution. A health care institution as defined in T.C.A. § 68-11-1602. (37) Health Care Provider. A person who is licensed, certified or otherwise authorized or permitted by the laws of this state to administer health care in the ordinary course of business or practice of a profession. (38) Hospital. Any institution, place, building or agency represented and held out to the general public as ready, willing and able to furnish care, accommodations, facilities and equipment for the use, in connection with services of a physician or dentist, to one (1) or more non-related persons who may be suffering from deformity, injury or disease or from any other condition for which nursing, medical or surgical services would be appropriate for care, diagnosis or treatment. All hospitals shall provide basic hospital functions and may provide optional services as delineated in these rules. A hospital shall be designated according to its classification and shall confine its services to those classifications described below. (a) General Hospital. To be licensed as a general hospital, the institution shall maintain and operate organized facilities and services to accommodate one or more non-related persons for a period exceeding twenty-four (24) hours for the diagnosis, treatment or care of such persons and shall provide medical and surgical care of acute illness, injury or infirmity and obstetrical care. All diagnosis, treatment and care shall be administered by or performed under the direction of persons currently licensed to practice the healing arts in the State of Tennessee. In addition, a general hospital must specifically provide: 1. An organized staff of professional, technical and administrative personnel. 2. A laboratory with sufficient equipment and personnel necessary to perform biochemical, bacteriological, serological and parasitological tests. 3. X-ray facilities which shall include, as a minimum requirement, a complete diagnostic radiographic unit. 4. A separate surgical unit which shall include, as minimum requirements, one operating room, a sterilizing room, a scrub-up area and workroom. 5. Obstetrical facilities which shall include, as minimum requirements, one delivery room, a labor room, a newborn nursery, an isolation nursery, and patient rooms designated exclusively for obstetrical patients. 6. An emergency department in accordance with Rule 0720-14-.07(5) of these standards and regulations. (b) Satellite Hospital. A satellite hospital may be licensed with a parent hospital upon approval by the Board for Licensing Health Care Facilities when they are on separate premises and are operated under the same management. (c) Chronic Disease Hospital. To be licensed as a chronic disease hospital, the institution shall be devoted exclusively to the diagnosis, treatment or care of persons needing medical, surgical or rehabilitative care for chronic or long-term illness, injury, or infirmity. The diagnosis, treatment or care shall be administered by or performed under the direction of persons currently licensed to practice the healing arts in the State of Tennessee. A chronic disease hospital shall meet the requirements for a general STANDARDS FOR HOSPITALS CHAPTER 0720-14 hospital except that obstetrical facilities are not required and, if the hospital provides no surgical services, an emergency department is not required. (d) Orthopedic Hospital. To be licensed as an orthopedic hospital, the institution shall be devoted primarily to the diagnosis and treatment of orthopedic conditions. An orthopedic hospital shall meet the requirements for a general hospital except that obstetrical services are not required and, if the hospital provides no surgical services, an emergency department is not required. (e) Pediatric Hospital. To be licensed as a pediatric hospital, the institution shall be devoted primarily to the diagnosis and treatment of pediatric cases and have on staff professional personnel especially qualified in the diagnosis and treatment of the diseases of children. A pediatric hospital shall meet the requirements of a general hospital except that obstetrical facilities are not required and if the hospital provides no surgical services, an emergency department is not required. (f) Eye, Ear, Nose, and Throat Hospital or any one of these. To be licensed as an eye, ear, nose and throat hospital, the institution shall be devoted primarily to the diagnosis and treatment of the diseases of the eye, ear, nose, and throat. The hospital shall have on staff professional personnel especially qualified in the diagnosis and treatment of diseases of the eye, ear, nose and throat. An eye, ear, nose and throat hospital shall meet the requirements for a general hospital except that obstetrical facilities are not required and, if the hospital provides no surgical services, an emergency department is not required. (g) Rehabilitation Hospital. To be licensed as a rehabilitation hospital, the institution shall be devoted primarily to the diagnosis and treatment of persons requiring rehabilitative services. A rehabilitation hospital shall meet the requirement of a general hospital except that radiology services, a surgical unit, obstetrical facilities, and an emergency department are not required. (h) Medical-Psychiatric Hospital. To be dually licensed as a medical-psychiatric hospital with Health Facilities Commission and Mental Health and Substance Abuse Services, the institution shall be primarily devoted to the diagnosis and treatment of persons requiring psychiatric services with the ability to treat the medical comorbidities of such person. A medical-psychiatric hospital shall meet the requirement of a general hospital except that radiology services, a surgical unit and maternity facilities are not required, and that the institution shall make the appropriate arrangements for such services as radiology and laboratory. A medical-psychiatric hospital may offer emergency services for psychiatric patients only. (39) Hospitalization. The reception and care of any person for a continuous period longer than twenty-four (24) hours, for the purpose of giving advice, diagnosis, nursing service or treatment bearing on the physical health of such persons, and maternity care involving labor and delivery for any period of time. (40) Incompetent. A patient who has been adjudicated incompetent by a court of competent jurisdiction and has not been restored to legal capacity. (41) Individual Instruction. An individual’s direction concerning a health care decision for the individual. (42) Infectious Waste. Solid or liquid wastes which contain pathogens with sufficient virulence and quantity such that exposure to the waste by a susceptible host could result in an infectious disease. STANDARDS FOR HOSPITALS CHAPTER 0720-14 (43) Involuntary Transfer. The movement of a patient between hospitals, without the consent of the patient, the patient’s legal guardian, next of kin or representative. (44) Justified Emergency. Includes, but is not limited to, the following events/occurrences: (a) An influx of mass casualties; (b) Localized and/or regional catastrophes such as storms, earthquakes, tornadoes, etc. or, (c) Epidemics or episodes of mass illness such as influenza, salmonella, etc. (45) Licensed Clinical Social Worker. A person currently licensed as such by the Tennessee Board of Social Workers. (46) Licensed Health Care Professional. Any health care professional currently licensed by the State of Tennessee to practice within the scope of a regulated profession, such as a nurse practitioner, dietitian, dentist, occupational therapist, pharmacist, physical therapist, physician, physician assistant, podiatrist, psychologist, clinical social worker, speech language pathologist, and emergency service personnel. (47) Licensed Practical Nurse. A person currently licensed as such by the Tennessee Board of Nursing. (48) Licensee. The person or entity to whom the license is issued. The licensee is held responsible for compliance with all rules and regulations. (49) Life Threatening or Serious Injury. Injury requiring the patient to undergo significant additional diagnostic or treatment measures. (50) Medical Emergency. A medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in placing the patient’s health in serious jeopardy, serious impairment to bodily functions or serious dysfunction of any bodily organ or part, which includes labor when delivery is imminent, when there is inadequate time to effect safe transfer to another hospital prior to delivery, or when a transfer may pose a threat to the health and safety of the patient or the unborn child. (51) Medical Record. Medical histories, records, reports, summaries, diagnoses, prognoses, records of treatment and medication ordered and given, entries, x-rays, radiology interpretations and other written electronics, or graphic data prepared, kept, made or maintained in a facility that pertains to confinement or services rendered to patients admitted or receiving care. (52) Medical Staff. An organized body composed of individuals appointed by the hospital governing board that operates under bylaws approved by the governing body and is responsible for the quality of medical care provided to patients by the hospital. All members of the medical staff shall be licensed to practice in Tennessee, with the exception of interns and residents. (53) Medically Inappropriate Treatment. Resuscitation efforts that cannot be expected either to restore cardiac or respiratory function to the patient or other medical or surgical treatments to achieve the expressed goals of the informed patient. In the case of the incompetent patient, the patient’s representative expresses the goals of the patient. STANDARDS FOR HOSPITALS CHAPTER 0720-14 (54) Member of the Professional Medical Community. A professional employed by the hospital and on the premises at the time of a voluntary delivery. (55) Mid-Level Practitioner. Either a certified nurse practitioner or a physician assistant. (56) Misappropriation of Patient/Resident Property. The deliberate misplacement, exploitation or wrongful, temporary or permanent use of an individual’s belongings or money without the individual’s consent. (57) Neglect. The failure to provide goods and services necessary to avoid physical harm, mental anguish or mental illness; however, the withholding of authorization for or provision of medical care to any terminally ill person who has executed an irrevocable living will in accordance with the Tennessee Right to Natural Death Law, or other applicable state law, if the provision of such medical care would conflict with the terms of the living will, shall not be deemed “neglect” for purposes of these rules. (58) N.F.P.A. The National Fire Protection Association. (59) Nuclear Medicine Technologist. A person currently registered as such by the National Association for Nuclear Medicine Technology. (60) Nurse-Midwife. A person currently licensed by the Tennessee Board of Nursing as a registered nurse (R.N.) and qualified to deliver midwifery services or certified by the American College of Nurse-Midwives. (61) Occupational Therapist. A person currently certified as such by the Tennessee Board of Occupational and Physical Therapy Examiners. (62) Occupational Therapy Assistant. A person currently certified as such by the Tennessee Board of Occupational and Physical Therapy Examiners. (63) Optometrist. A person currently licensed as such by the Tennessee Board of Optometry. (64) Patient. Includes but is not limited to any person who is suffering from an acute or chronic illness or injury or who is crippled, convalescent or infirm, or who is in need of obstetrical, surgical, medical, nursing or supervisory care. (65) Person. An individual, corporation, estate, trust, partnership, association, joint venture, government, governmental subdivision, agency, or instrumentality, or any other legal or commercial entity. (66) Personally Informing. A communication by any effective means from the patient directly to a health care provider. (67) Pharmacist. A person currently licensed as such by the Tennessee Board of Pharmacy. (68) Physical Therapist. A person currently certified as such by the Tennessee Board of Occupational and Physical Therapy Examiners. (69) Physical Therapy Assistant. A person currently certified as such by the Tennessee Board of Occupational and Physical Therapy Examiners. (70) Physician. An individual authorized to practice medicine or osteopathy under Tennessee Code Annotated, Title 63, Chapters 6 or 9. STANDARDS FOR HOSPITALS CHAPTER 0720-14 (71) Physician Assistant. A person who has graduated from a physician assistant educational program accredited by the Accreditation Review Commission on Education for the Physician Assistant, has passed the Physician Assistant National Certifying Examination, and is currently licensed in Tennessee as a physician assistant under Title 63, Chapter 19. (72) Physician Orders for Scope of Treatment or POST. Written orders that: (a) Are on a form approved by the Board for Licensing Health Care Facilities; (b) Apply regardless of the treatment setting and that are signed as required herein by the patient’s physician, physician assistant, nurse practitioner, or clinical nurse specialist; and (c) 1. Specify whether, in the event the patient suffers cardiac or respiratory arrest, cardiopulmonary resuscitation should or should not be attempted; 2. Specify other medical interventions that are to be provided or withheld; or 3. Specify both 1. and 2. (73) Podiatrist. A person currently licensed as such by the Tennessee Board of Registration in Podiatry. (74) Power of Attorney for Health Care. The designation of an agent to make health care decisions for the individual granting the power under T.C.A. Title 34, Chapter 6, Part 2. (75) Psychologist. A person currently licensed as such by the Tennessee Board of Examiners in Psychology. (76) Qualified Emergency Medical Service Personnel. Includes, but shall not be limited to, emergency medical technicians, paramedics, or other emergency services personnel, providers, or entities acting within the usual course of their professions, and other emergency responders. (77) Radiological Technologist. A person currently registered as such by the American Society of Radiological Technologists. (78) Reasonably Available. Readily able to be contacted without undue effort and willing and able to act in a timely manner considering the urgency of the patient’s health care needs. Such availability shall include, but not be limited to, availability by telephone. (79) Registered Health Information Administrator (RHIA). A person currently registered as such by the American Health Information Management Association. (80) Registered Health Information Technician (RHIT). A person currently accredited as such by the American Health Information Management Association. (81) Registered Nurse. A person currently licensed as such by the Tennessee Board of Nursing. (82) Rural Area. A county classified by the federal Office of Management and Budget (OMB) as rural, all counties, excluding Davidson, Hamilton, Knox, and Shelby, currently defined as rural in Chapter 1200-20-11 of the Tennessee Comprehensive Rules and Regulations, or an area outside of a county or part of a county previously classified as rural by the OMB and reclassified by the OMB as a metropolitan statistical area as of June 6, 2003. (83) Rural Emergency Hospital. A Rural Emergency Hospital (“REH”) is a facility that: STANDARDS FOR HOSPITALS CHAPTER 0720-14 (a) Meets the eligibility requirements for a licensed hospital in Tennessee pursuant to Tenn. Comp. R. & Regs. 0720-14-.01(37), and the following additional requirements: 1. Is enrolled for reimbursement as a rural emergency hospital by the federal Centers for Medicare and Medicaid Services pursuant to 42 U.S.C. §§ 1395x(kkk) et. seq. and 42 U.S.C. § 1395cc(j), or any successor statute; 2. Provides rural emergency hospital services; 3. Provides an emergency department which maintains: (i) Availability twenty-four (24) hours a day seven (7) days per week. (ii) A physician, physician assistant, or nurse practitioner, who performs such services as such individual is legally authorized to perform in accordance with state law and who meets training, education, and experience requirements required by state law. (iii) Such clinician must be on call at all times and available on-site within thirty (30) minutes to sixty (60) minutes depending on the facility’s location. (iv) Staffed twenty-four (24) hours per day and (7) seven days per week by individuals competent in the skills needed to address emergency medical care and must be able to receive patients and activate appropriate medical resources to meet the care needed by patients. 4. Has a transfer agreement in effect with a level I or level II trauma center; and 5. Meets such other licensure, staff training and education requirements as the Health Facilities Commission finds necessary in the interest of the health and safety of individuals who are provided rural emergency hospital services. 6. A Rural Emergency Hospital does not have inpatient beds or provide any acute inpatient services, other than those which are rendered by a licensed skilled nursing facility to furnish post-hospital extended care services, which is a distinct part unit of the Rural Emergency Hospital. 7. Nothing in this definition expands on the scope of a licensed healthcare professional’s ability to practice under their respective regulated profession. (84) Rural Emergency Hospital Services. The term “rural emergency hospital services” means the following services, provided by a Rural Emergency Hospital, that do not exceed an annual per-patient average of twenty-four (24) hours in such Rural Emergency Hospital: (a) Emergency department services, and observation care; and (b) At the election of the Rural Emergency Hospital, for services provided on an outpatient basis, other medical and health services as specified in regulations adopted by the United States Secretary of Health and Human Services and authorized by the applicable rules or statutes of the Health Facilities Commission. (85) Satellite Hospital. A freestanding hospital licensed with a parent hospital that is on separate premises and operated under the same management. (86) Shall or Must. Compliance is mandatory. STANDARDS FOR HOSPITALS CHAPTER 0720-14 (87) Social Worker. A person who has at least a bachelor’s degree in Social Work or related field, and preferably, two (2) years medical social work or other community based work experience. (88) Stabilize. To provide such medical treatment of the emergency medical condition as may be necessary to assure, within reasonable medical probability, that the condition will not materially deteriorate due to the transfer as determined by a physician or other qualified medical personnel when a physician is not readily available. (89) State. A state of the United States, the District of Columbia, the Commonwealth of Puerto Rico, or a territory or insular possession subject to the jurisdiction of the United States. (90) Student. A person currently enrolled in a course of study that is approved by the appropriate licensing board. (91) Supervising Health Care Provider. The designated physician or, if there is no designated physician or the designated physician is not reasonably available, the health care provider who has undertaken primary responsibility for an individual’s health care. (92) Surgical Technologist. A person who works under supervision to facilitate the safe and effective conduct of invasive surgical procedures. This individual is usually employed by a hospital, medical office, or surgical center and supervised during the surgical procedure according to institutional policy and procedure to assist in providing a safe operating room environment that maximizes patient safety by performing certain tasks including, but not limited to: (a) Preparation of the operating room and the sterile field for surgical procedures by preparing sterile supplies, instruments, and equipment using sterile technique; (b) Preparation of the operating room for surgical procedures by ensuring that surgical equipment is functioning properly and safely; and (c) Passing instruments, equipment or supplies to a surgeon, sponging or suctioning an operative site, preparing and cutting suture material, holding retractors, transferring but not administering fluids or drugs, assisting in counting sponges, needles, supplies, and instruments, and performing other similar tasks as directed during a surgical procedure. (93) Surrogate. An individual, other than a patient’s agent or guardian, authorized to make a health care decision for the patient. (94) Transfer. The movement of a patient between hospitals at the direction of a physician or other qualified medical personnel when a physician is not readily available but does not include such movement of a patient who leaves the facility against medical advice. The term does not apply to the commitment and movement of mentally ill and mentally retarded persons and does not apply to the discharge or release of a patient no longer in medical need of hospital care or to a hospital’s refusal, after an appropriate medical screening, to render any medical care on the grounds that the person does not have a medical need for hospital care. (95) Treating Health Care Provider. A health care provider who at the time is directly or indirectly involved in providing health care to the patient. (96) Treating Physician. The physician selected by or assigned to the patient and who has the primary responsibility for the treatment and care of the patient. Where more than one STANDARDS FOR HOSPITALS CHAPTER 0720-14 physician shares such responsibility, any such person may be deemed to be the “treating physician.” (97) Voluntary Delivery. The action of a mother in leaving an unharmed infant aged seventy-two (72) hours or younger on the premises of a hospital with any hospital employee or member of the professional medical community without expressing any intention to return for such infant, and failing to visit or seek contact with such infant for a period of thirty (30) days thereafter.