[38 Pa.B. 573]
[Saturday, January 26, 2008]
[Continued from previous Web Page] Section 117.58. Exemption for hospitals providing limited emergency services.
Some commentators suggested the Department revise the proposed rulemaking to prevent hospitals from electing not to provide emergency services to sexual assault victims under § 117.58. One commentator suggested the Department more specifically define who is permitted to exempt themselves from the regulations under this exemption. Conversely, one commentator noted it was appropriate to allow hospitals to individually determine whether nor not they would provide emergency services to sexual assault victims, to ensure victims receive treatment in hospitals with more experience and whose practitioners are proficient in the treatment of sexual assaults. That commentator, however, did have concerns about some of the more proficient hospitals electing not to provide sexual assault emergency services.
Generally, the Department's regulations relating to health care facilities do not require hospitals to provide any specific services or treatment or any particular level of services. However, the existing hospital regulations do provide hospitals with guidelines for determining which level of emergency services to provide based on the scope of services otherwise generally provided by the hospital. Specifically, § 117.13 (relating to scope of services) provides for three levels of care which are acceptable in a hospital, ranging from full ''effective care for any type of patient requiring emergency services'' by hospitals that otherwise ''offer a broad range of services,'' (§ 117.13(1)) to allowing hospitals to ''refer all emergency patients after institution of essential life-saving measures'' for hospitals that otherwise offer only ''the most limited range of services.'' (§ 117.13(3).) Based on the concerns raised by some commentators on the exemption provisions in § 117.58, the Department has revised this section to allow only hospitals with the ''most limited range of services'' to continue to refer all emergency patients and exempt themselves from treating sexual assault victims in accordance with the regulations. These hospitals currently have procedures for ensuring patients in need of emergency services are not transported to their facilities and for referral and transfer of those who nevertheless present at the hospital. However, nothing should be construed to prevent a hospital operating an emergency service area under § 117.13(3) from providing emergency services to sexual assault victims if that hospital believes it can appropriately provide the services and the community which they serve would benefit from them providing the services. Hospitals electing not to provide services must still comply with certain notification provisions and should transfer victims in accordance with their current transfer policies.
Some commentators were concerned as to how a hospital electing not to provide sexual assault emergency services should respond to a victim who presents with a need for services relating to the sexual assault but not directly covered by these regulations, such as injuries from a physical assault. Again, the revisions made by the Department address these concerns. Hospitals governed by this section should have current policies and procedures that include provisions to deal with stabilizing the victim prior to transfer to another facility. These policies and procedures would apply for transfer and transport of sexual assault victims.
Another commentator asked whether hospitals that elect not to provide emergency contraception under the religious and moral exemption in § 117.57 in only limited circumstances must still comply with the notification provisions. Although the refusal by these hospitals to provide emergency contraception may be limited, the fact that a hospital could legally exercise its religious rights to deny emergency contraception demands that the public be notified to limit the occasions in which a victim will be required to receive services in piecemeal fashion. Accordingly, all hospitals which at any time may deny emergency contraception under a stated religious or moral belief must comply with the notification provisions of this section. To clarify this requirement, the regulations have been revised to include separate notification provisions in § 117.57 and this section.
Some commentators asked which law enforcement agencies and ambulance and emergency medical care and transport services must be notified under the provisions of proposed subsection (a). Under existing regulations, hospitals are required to develop a community based plan for the provisions of emergency services. (See §§ 117.11--117.15.) This plan is to be developed ''with community participation and be coordinated with the local emergency health services council.'' (§ 117.15(b)(1).) Based on these existing provisions, hospitals are aware of the law enforcement agencies and ambulance and emergency medical care and transport services which may transport sexual assault victims to their facilities. Accordingly, the Department has made no revisions to the regulations.
One commentator suggested the Department require that hospitals notify their local emergency health services council of their exercise of either of the exemptions in proposed § 117.57 or this section. As stated previously, a hospital's community based plan is to be developed ''with community participation and be coordinated with the local emergency health services council.'' (§ 117.15(b)(1).) Therefore, notification can be achieved pursuant to existing regulatory requirements. Furthermore, as the Department will publish notice in the Pennsylvania Bulletin of hospitals operating under the exemptions in § 117.57 and this section, there are adequate provisions to ensure these groups will be notified. (See §§ 117.57(1)(ii) and 117.58(1)(ii).) The Department has made no revisions to this section.
One commentator suggested hospitals be required to provide posted notice at the facility if they do not provide sexual assault victim emergency services under the exemption proposed in this section. The Department has revised the regulations to incorporate the commentator's suggestion. (See § 117.58(5).)
Another commentator suggested the Department require hospitals notify the applicable law enforcement agency if they receive and transfer a sexual assault victim under the provisions of proposed § 117.58. To respect the privacy of the victim, and in light of the possibility that the victim may not desire to report the crime to law enforcement, revisions have not been made to address these comments. Hospitals are nevertheless required to comply with any laws requiring notification to law enforcement of the treatment of victims of crimes, and nothing in these regulations should be construed as superseding those requirements.
Some commentators were concerned the exemption provisions of § 117.58 might limit the number of hospitals providing emergency services to sexual assault victims and increase the time it takes to transport a victim to a hospital. The commentators argued this could lead to higher costs, reduction on the number of ambulances available to respond to the emergency calls at a particular time, limit patient choice and delay treatment. One commentator asked the Department to remove ''at no cost'' from proposed subsection (b)(2) in response to concerns of how these costs would be reimbursed.
The Department believes the revisions made to the regulations to allow only those hospitals providing emergency services under § 117.13(3) to exempt themselves from these regulations resolve these concerns. It is unlikely that victims are currently being taken to these facilities as the ambulance and law enforcement communities should be aware of which hospitals provide the broader range of services necessary for the appropriate treatment of a sexual assault victim. If a victim presents at one of these hospitals, there are procedures in the hospital's current operations for properly transferring the victim to a hospital that can appropriately provide the required services.
These revisions also address the concerns of commentators regarding who will pay for the transfer of these victims when they present to a hospital that does not provide sexual assault emergency services. Current practices with regards to these transfer costs may also be applied for the treatment sought for a sexual assault. As the transfer procedures for these hospitals are currently in place, the Department has removed ''at no cost'' from proposed subsection (b)(2) (renumbered as paragraph (6)) to eliminate any interference with those standing procedures.
Some commentators raised similar issues with respect to EMTALA and ambulance transfers with respect to this section and § 117.57. Commentators questioned the Department's authority to promulgate a regulation, and whether the ambulance community must respond if the transfer is not considered medically necessary. Commentators also raised the same issues regarding the applicability of EMTALA to hospitals that do not provide any sexual assault emergency services. These concerns are addressed in response to the comments relating to § 117.57. Further, they are also resolved by the revisions to this section, as current policies and procedure for the hospitals operating emergency services areas under § 117.13(3), which should be in compliance with State and Federal law and EMTATA, would apply to transfers and transports of sexual assault victims.
Some commentators, including IRRC, requested that additional guidance be included in the regulations for the term ''close proximity'' as used in proposed § 117.57, or to change this term to require transport to the ''closest'' hospital. The Department has revised paragraph (6) to address these concerns by incorporating the latter recommendation. (See § 117.58(6).)
IRRC suggested the final-form rulemaking clarify that the notification provisions of proposed subsection (a) apply to two types of exemptions, the exemption from providing only emergency contraception under proposed § 117.57 and the exemption from providing any sexual assault victim emergency services under proposed § 117.58. The Department has revised the regulations in response to this comment by providing separate notification requirements in §§ 117.57 and 117.58.
IRRC also suggested the Department clarify when the list of hospitals not providing services will be published. The Department has revised the regulations to provide that the list will be published annually. (See § 117.58(1)(ii).) Also, the Department will post the most recent listing on its website to reduce the need to regularly update the list between annual publications.
IRRC also suggested the regulations require ambulance or emergency medical service transport personnel inform victims of their hospital choices and whether emergency contraception would be available at certain hospitals. Although this information is very useful for victims, these regulations provide for requirements for hospital, and do not pertain to ambulance or emergency medical services personnel. However, ambulance and emergency medical services personnel are encouraged to provide sexual assault victims with any information the victim may find useful in seeking treatment for the sexual assault.
C. Affected Persons
This final-form rulemaking will affect all hospitals in this Commonwealth licensed by the Department, which will be required to consider whether or not they will provide sexual assault emergency services. Those hospitals eligible for one of the exemptions under § 117.57 or § 117.58, and electing to exercise one of those exemptions, will be required to inform the Department, ambulance and emergency medical care and transport services, and law enforcement agencies of this decision within a specified time frame. Further, hospitals choosing not to provide these services under § 117.57 or § 117.58 will be required to develop policies and procedures for informing sexual assault victims of the hospital's position on these issues, and for arranging to transport or transfer victims who request to be taken to locations that do provide the applicable services.
Hospitals required to provide sexual assault emergency services will need to develop policies and procedures to comply with the regulations, including those relating to provision of informational materials relating to emergency contraception, sexually transmitted diseases, and pregnancy.
This final-form rulemaking will also affect sexual assault victims, who will be offered the same information and care at all hospitals in this Commonwealth required to provide sexual assault emergency services. Victims will also be offered the opportunity to be transported to hospitals that did offer these services, if they present at a hospital that does not do so.
Lastly, this final-form rulemaking will affect law enforcement agencies and ambulance and emergency medical care and transport services, since those groups should make efforts to be aware of the list of hospitals that provide sexual assault emergency services, so that a victim may be taken to a hospital where the victim will receive appropriate sexual assault emergency services.
D. Cost and Paperwork Estimate
1. Cost
a. Commonwealth
There will be additional costs to the Commonwealth resulting from this final-form rulemaking associated with the Department's need to enforce the regulations. The Department estimates an additional position for a Health Facility Quality Administrator will be required to survey and inspect hospitals to ensure compliance with the regulations and respond to complaints relating to the manner in which these regulations will be implemented by the hospitals. These costs will include salary, benefits, workstation, computer, telephone, travel, training, and other related costs. Reducing the effects a sexual assault will have on victims through implementation of the regulations and the services offered through them, however, would outweigh the estimated costs.
The Department will also incur costs for the development of the written emergency contraception informational materials. The Department estimates that it will cost approximately $4,500 to develop the written informational materials in seven languages and in an English audio format. Additionally, the Department could add an additional language translation of the informational brochures each year to increase the accessibility of this information to all persons in this Commonwealth.
b. Local Government
There will be no additional cost to local government. Although the regulations will require that hospitals exercising either of the exemptions under § 117.57 or § 117.58 to send notice to law enforcement agencies of their decision not to provide those services, this requires no additional work on the part of law enforcement agencies. The Department will publish, on an annual basis, a compiled list of those hospitals in the Pennsylvania Bulletin, and post the list on its website.
c. Regulated Community
There will be additional cost to hospitals in this Commonwealth. Although the Department will develop the information materials regarding emergency contraception, hospitals will be required to obtain the electronic format of these materials from the Department and print them so that they may be provided to sexual assault victims they treat. The Department estimates the full color printing costs to range from $ 0.20 to $ 0.50 per page depending on the quantity and quality of the printing. Based on the high cost in this range and a printing of 5,000 brochures per year, the Department estimates it would cost the regulated community $2,500 per year to comply with these provisions of the regulations.
In addition to these costs, hospitals could have additional costs of reviewing current procedures and making any changes necessary to comply with the regulations. These costs will depend upon what procedures individual hospitals in this Commonwealth currently have in place. However, hospitals may be able to reduce their costs by coordination of these efforts.
d. General Public
There is no additional cost for the general public. In fact, since victims of rapes and other sexual offenses and their families are members of the general public, and may be subject to serious medical and psychological effects as a result of the crime, including sexually transmitted disease and pregnancy, there will be a benefit to the general public from the implementation of these regulations. Because the regulations will also aid in gathering information necessary for investigation and successful prosecution of a violent crime, society as a whole will benefit from the implementation of the regulations.
2. Paperwork Estimates
a. Commonwealth
To effectively survey and inspect hospitals for the purpose of enforcing the regulations, the Department estimates additional survey and inspection time equivalent to an additional position for one Health Facility Quality Administrator will be necessary. There will be the need to review complaints in this additional area of regulation; the Department, however, already has a process in place for the review and investigation of complaints against hospitals.
Further, the Department will be required to obtain and compile a list of hospitals that are eligible and claim one of the exemptions under § 117.57 or § 117.58, and to publish that list, on an annual basis, in the Pennsylvania Bulletin, and post the list on its website.
The Department will also be required to produce written emergency contraception information materials which will be made available to hospitals for distribution to sexual assault victims in accordance with the requirements of the regulations. The Department proposes to produce these materials in a variety of languages and in audio format.
b. The Regulated Community
Hospitals will be required to either develop or obtain informational materials on sexually transmitted diseases, pregnancy, emergency contraception and the need for additional testing. However, documents and written guidance currently exist relating to these topics, many of which are currently in use by hospitals in this Commonwealth.
Hospitals will also be required to review current policies and procedures and make any changes necessary to comply with the regulations. Whether additional or revised policies or procedures are necessary depend upon what policies and procedures each hospital currently has in place.
b. Local Government
There is no additional paperwork requirement for local government. Although the final-form rulemaking will require that hospitals eligible for and exercising either of the exemptions under § 117.57 or § 117.58 to send notice to law enforcement agencies of their decision not to provide emergency contraception or sexual assault emergency services, this requires no additional work on the part of law enforcement agencies. The Department will publish a compiled list in the Pennsylvania Bulletin on an annual basis.
c. General Public
There is no additional paperwork requirement for the general public.
E. Statutory Authority
Section 803(2) of the Health Care Facilities Act (act) (35 P. S. § 448.803(2)), authorizes the Department to promulgate, after consultation with the Health Policy Board, regulations necessary to carry out the purposes and provisions of the act. See also, 35 P. S. § 448.601 (''The Department, in the exercise of its duties under this act shall have the power to adopt such regulations as are necessary to carry out the purposes of this act.'') Section 801.1 of the act (35 P. S. § 448.801a), provides that a purpose of the act is to promote the public health and welfare through the establishment of regulations setting minimum standards for the operation of health care facilities. The same section provides that the minimum standards are to assure safe, adequate and efficient facilities and services, and are also to promote the health, safety and adequate care of patients or residents of the facilities. The General Assembly has also stated that a purpose of the act is, among other things, to assure that all citizens receive humane, courteous and dignified treatment. See 35 P. S. § 448.102. Finally, the act provides the Department with explicit authority to enforce its rules and regulations promulgated under the act. See 35 P. S. § 448.201(12).
The Department also has the duty to protect the health of the people of this Commonwealth under section 2102(a) of The Administrative Code of 1929 (71 P. S. § 532(a)). The Department has general authority to promulgate regulations under the Code for this purpose. See 71 P. S. § 532(g).
F. Effectiveness/Sunset Dates
This final-form rulemaking will become effective upon its publication in the Pennsylvania Bulletin. No sunset date has been established. The Department will continually review and monitor the effectiveness of these regulations.
G. Regulatory Review
Under section 5(a) of the Regulatory Review Act (71 P. S. § 745.5(a)), the Department submitted a copy of a notice of proposed rulemaking, published at 36 Pa.B. 6403 (October 21, 2006), to the Independent Regulatory Review Commission (IRRC) and to the Chairpersons of the House Health and Human Services Committee and the Senate Public Health and Welfare Committee. In compliance with section 5(c) of the Regulatory Review Act, the Department also provided IRRC and the Committees with copies of all comments received during the formal comment period, as well as other documentation.
In compliance with section 5.1(a) of the Regulatory Review Act, the Department submitted a copy of the final-form regulations to IRRC and the Committees on Monday, September 17, 2007. In addition, the Department provided IRRC and the Committees with information pertaining to commentators and a copy of a detailed Regulatory Analysis Form prepared by the Department. A copy of this material is available to the public upon request.
In preparing this final-form rulemaking, the Department has considered all comments received from IRRC, the Committees and the public.
This final-form rulemaking was deemed approved by the House Health and Human Services Committee and by the Senate Public Health and Welfare Committee on October 17, 2007. IRRC met on October 18, 2007, and approved the regulations in accordance with section 5.1(e) of the Regulatory Review Act. The Attorney General approved the regulations on January 9, 2008.
H. Contact Person
Questions regarding these regulations may be submitted to Sandra Knoble, Acting Director, Bureau of Facility Licensure and Certification, Department of Health, Room 932, Health and Welfare Building, 7th and Forster Streets, Harrisburg, PA 17120, (717) 787-8015. Persons with a disability may submit questions in alternative format such as by audio tape, Braille or by using V/TT (717) 783-6514 or the Pennsylvania AT&T Relay Service at (800) 654-5984 (TT). Persons who require an alternative format of this document may contact Sandra Knoble at that address or telephone numbers so that necessary arrangements may be made.
I. Findings
The Department, after consultation with the Health Policy Board, finds that:
(1) Public notice of intention to adopt the regulations adopted by this order has been given under sections 201 and 202 of the act of July 31, 1968 (P. L. 769, No. 240) (45 P. S. §§ 1201 and 1202), and the regulations thereunder, 1 Pa. Code §§ 7.1 and 7.2.
(2) A public comment period was provided as required by law and all comments were considered.
(3) The adoption of regulations in the manner provided by this order is necessary and appropriate for the administration of the authorizing statute.
J. Order
The Department, after consultation with the Health Policy Board, acting under the authorizing statute, orders that:
(1) The regulations of the Department, 28 Pa. Code Chapters 101 and 117, are amended by adding §§ 117.51--117.58 and by amending §§ 101.4, 117.15 and 117.41 to read as set forth in Annex A, with ellipses referring to the existing text of the regulations.
(2) The Secretary of Health shall submit this order and Annex A to the Office of General Counsel and the Office of Attorney General for approval as required by law.
(3) The Secretary of Health shall submit this order, Annex A and a Regulatory Analysis Form to IRRC, the House Committee on Health and Human Services and the Senate Committee on Public Health and Welfare for their review and action as required by law.
(4) The Secretary of Health shall certify this order and Annex A and deposit them with the Legislative Reference Bureau as required by law.
(5) This order shall take effect immediately upon publication in the Pennsylvania Bulletin.
CALVIN B. JOHNSON, M. D., M.P.H.,
Secretary(Editor's Note: For the text of the order of the Independent Regulatory Review Commission relating to this document, see 37 Pa.B. 5951 (November 3, 2007).)
Fiscal Note: 10-182. (1) General Fund; (2) Implementing Year 2007-08 is $40,000; (3) 1st Succeeding Year 2008-09 is $80,997; 2nd Succeeding Year 2009-10 is $85,765; 3rd Succeeding Year 2010-11 is $90,837; 4th Succeeding Year 2011-12 is $97,433; 5th Succeeding Year 2012-13 is $101,973; (4) 2006-07 Program--$16,057,000; 2005-06 Program--$14,529,526; 2004-05 Program--$14,157,071; (7) Quality Assurance; (8) recommends adoption.
Annex A
TITLE 28. HEALTH AND SAFETY
PART IV. HEALTH FACILITIES
Subpart B. GENERAL AND SPECIAL HOSPITALS
CHAPTER 101. GENERAL INFORMATION § 101.4. Definitions.
The following words and terms, when used in this subpart, have the following meanings, unless the context clearly indicates otherwise:
* * * * * Emergency contraception--
(i) A drug, drug regime or device approved by the Food and Drug Administration that is used after sexual intercourse to inhibit or prevent ovulation or fertilization.
(ii) The term also includes a drug, drug regime or device approved by the Food and Drug Administration that is used after sexual intercourse to inhibit or prevent the implantation of a fertilized ovum within the uterus.
* * * * * Rape crisis center--An office, institution or center that offers assistance to a sexual assault victim or the victim's family through crisis intervention, medical and legal accompaniment and follow-up counseling.
* * * * * Sexual assault--Any offense specified in 18 Pa.C.S. Chapter 31, Subchapter B (relating to definition of offenses), except that the term does not include indecent exposure as defined in 18 Pa.C.S. § 3127 (relating to indecent exposure) or sexual intercourse with an animal as defined in 18 Pa.C.S. § 3129 (relating to sexual intercourse with animal).
Sexual assault counselor--A person who is engaged or employed by a rape crisis center that arranges for the provision of services to a sexual assault victim, who has undergone at least 40 hours of sexual assault training and is under the control of a direct services supervisor of a rape crisis center, whose primary purpose is the rendering of advice, counseling or assistance to victims of sexual assault.
Sexual assault emergency services--A medical examination, forensic examination, or other procedure or service provided by a hospital to a sexual assault victim because of a sexual assault.
Sexual assault victim or victim--A person who has been sexually assaulted.
* * * * *
CHAPTER 117. EMERGENCY SERVICES § 117.15. Community-based plan.
(a) Every hospital, its governing board, its chief administrative officer and its medical staff shall promote and assist other local agencies to develop a written community-based emergency plan.
(b) The plan must:
(1) Be developed with community participation and be coordinated with the local emergency health services council, where one exists.
(2) Indicate where cooperative arrangements, if any, have been made with other local hospitals to coordinate emergency services, especially when the hospital offers a very limited range of emergency services.
(3) Indicate what arrangements with other local hospitals, agencies or municipal services have been made for transportation in receiving and referring emergency cases and for communication among relevant institutions and services.
(4) State specifically what services are available and what administrative procedures shall be followed for prompt, medically appropriate treatment of patients whose emergency conditions:
(i) Are psychiatrically related.
(ii) Involve the use of drugs or alcohol.
(iii) Arise from an alleged criminal act, including specific procedures in the case of an alleged sexual assault.
(iv) Arise from a motor vehicle accident.
(v) Involve radioactive contamination.
POLICIES AND PROCEDURES § 117.41. Emergency patient care.
(a) Emergency patient care shall be guided by written policies and procedures which delineate the proper administrative and medical procedures and methods to be followed in providing emergency care. These policies and procedures shall be clear and explicit; approved by the medical staff and hospital governing body; reviewed annually; revised as necessary; and dated to indicate the date of the latest review or revision, or both.
(b) Policies and procedures for emergency patient care should, at a minimum, do the following:
(1) Provide for the admission of a patient if, in the judgment of the physician, admission is warranted.
(2) Provide for the referral and placement of patients whose needs cannot be met by the hospital.
(3) Establish procedures to minimize the possibility of cross-infection and contamination.
(4) Provide for the discharge of patients only upon written orders of a physician. Telephone discharge orders may be accepted in accordance with § 107.62 (relating to oral orders).
(5) Specify explicitly the location and mode of storage of medications, supplies and special equipment.
(6) Establish methods for 24-hour-a-day procurement of equipment and drugs.
(7) Establish procedures for notification of the personal physician of the patient and the transmission of relevant reports to the physician.
(8) Establish procedures on disclosure of patient information. Policies on confidentiality of emergency room records must be the same as those which apply to other hospital medical records. The identity and the general condition of the patient may be released to the public after the next of kin have been notified.
(9) Plan for communication with police, local or State health or welfare authorities as appropriate, regarding accident victims and patients whose condition or its cause is reportable, for example, persons having contagious diseases or victims of suspected criminal acts such as sexual assault or gunshot wounds, see 18 Pa.C.S. § 5106 (relating to failure to report injuries by firearm or criminal act), and child abuse, see 23 Pa.C.S. Chapter 63 (relating to Child Protective Services).
(10) Instruct personnel in special procedures for handling persons who are mentally ill, under the influence of drugs or alcohol, victims of suspected criminal acts or contaminated by radioactive material or who otherwise require special care or have other conditions requiring special instructions.
(11) Instruct personnel how to deal with patients who are dead on arrival.
(12) Provide for a review by the appropriate committee of the medical staff of each death occurring on the emergency service or, if there is no service, of each death occurring during the performance of essential life-saving measures prior to transfer to another facility.
(13) Explain the role of the emergency service in the hospital's disaster plan established in accordance with Chapter 151 (relating to fire, safety and disaster services).
(14) Delineate medical staff obligations for emergency patient care.
(15) Specify which procedures may not be performed in the emergency area.
(16) Provide for appropriate utilization of any beds used for observation.
(17) Establish procedures to be used when the patient is required to return to the hospital for treatment, for example, when treatment is impossible to arrange otherwise.
(18) Establish procedures for early transfer of severely ill or injured patients to special treatment areas within the hospital, such as the surgical suite, the intensive care unit or the cardiac care unit.
(19) Delineate instructions to be given to a patient or the patient's family, or both, or others as appropriate regarding follow-up care.
(20) Make available to the emergency service current toxicological reference material along with the telephone numbers of the regional poison control center.
(21) Provide for the ready availability of reference materials and charts relating to the initial treatment of burns, cardiopulmonary resuscitation and tetanus immunization.
(22) Provide for effective coordination with outpatient services, where these services are provided.
(23) Establish procedures to clearly inform patients of emergency service billing policies, including prominent display of that information in the emergency service area. This information must indicate whether patients are to be billed separately for physicians' services and other emergency services. Those hospitals having an obligation under section 2 of the Hospital Survey and Construction (Hill-Burton) Act (42 U.S.C.A. §§ 291--291o), shall comply with the provisions of that act as it relates to free and low-cost care.
SEXUAL ASSAULT VICTIM EMERGENCY SERVICES § 117.51. Scope.
Except as otherwise provided by §§ 117.57 and 117.58 (relating to religious and moral exemptions; and exemption for hospitals providing limited emergency services), a hospital shall provide sexual assault emergency services to a sexual assault victim in accordance with this section and §§ 117.52--117.58 (relating to sexual assault victim emergency services).
(1) A hospital that does not provide emergency contraception under the exemption in § 117.57 shall comply with the notification and transport provisions of that section.
(2) A hospital that provides the most limited range of services and elects to refer all emergency patients after institution of essential life-saving measures in accordance with § 117.13(3) (relating to scope of services), and elects not to provide any sexual assault emergency services under § 117.58, shall comply with the notification and transfer provisions of that section.
§ 117.52. Minimum requirements for sexual assault emergency services.
(a) Promptly upon a sexual assault victim presenting to a hospital that provides sexual assault emergency services, or as immediately thereafter as medically appropriate depending on the condition of the victim, the hospital shall, at a minimum and in addition to any other services required by the condition of the victim, provide, with the consent of the victim, the following:
(1) Medical examinations and laboratory or diagnostic tests required to ensure the health, safety and welfare of the victim, or which may be used as evidence in a criminal proceeding against a person accused of the sexual assault, or both. A hospital shall utilize a rape kit that complies with the minimum standard requirements developed by the Department or that is otherwise approved by the Department under the Sexual Assault Testing and Evidence Collection Act (35 P. S. §§ 10172.1--10172.4). The Department will publish a notice of minimum standard requirements for rape kits or approved rape kits in the Pennsylvania Bulletin.
(2) Oral and written information concerning the possibility of a sexually transmitted disease and pregnancy resulting from the sexual assault.
(3) Oral and written information concerning accepted medical procedures, medication and possible contraindi- cations of the medication available for the prevention or treatment of infection or disease resulting from the sexual assault.
(4) Medication as deemed appropriate by the attending physician, including HIV and sexually transmitted disease prophylaxis.
(5) Tests and examinations as medically indicated to determine the presence or absence of a sexually transmitted disease.
(6) Oral and written instructions advising of the need for additional blood tests at time periods after the sexual assault as medically indicated to determine the presence or absence of a sexually transmitted disease.
(7) Information on the availability of a rape crisis center or sexual assault counselor and the telephone number of a local rape crisis center or sexual assault counselor. The hospital shall promptly contact the local rape crisis center or sexual assault counselor at the request of the victim.
(8) The opportunity for the victim to consult with the rape crisis center or sexual assault counselor in person and in private while at the hospital.
(9) Emergency contraception under § 117.53 (relating to emergency contraception) for a female sexual assault victim.
(b) A hospital shall maintain records of the results of all examinations, tests and services provided to a sexual assault victim in accordance with Chapter 115 (relating to medical record services) and other applicable laws and regulations, and make those records available to law enforcement officials upon the request and with the consent of the sexual assault victim.
§ 117.53. Emergency contraception.
A hospital shall provide the following services to a female sexual assault victim in addition to the minimum requirements set forth in § 117.52 (relating to minimum requirements for sexual assault emergency services):
(1) Provide the victim with written informational materials regarding emergency contraception prepared under § 117.55 (relating to emergency contraception informational materials).
(2) Objectively and orally inform the victim of the availability of emergency contraception, its use, risks and efficacy.
(3) Offer emergency contraception to the victim and provide emergency contraception onsite upon the victim's request, unless medically contraindicated or unless the hospital claims an exemption in accordance with § 117.57 (relating to religious and moral exemptions).
§ 117.54. Prevention of sexually transmitted diseases.
(a) A hospital shall provide a sexual assault victim with an assessment of the victim's risk for contracting a sexually transmitted disease, hepatitis and HIV.
(b) The hospital shall base the risk assessment upon the following considerations:
(1) Available information regarding the assault as well as the subsequent findings from medical examinations and tests that may be conducted.
(2) Established standards of risk assessment, including consideration of recommendations made by the United States Department of Health and Human Services Centers for Disease Control and Prevention.
(c) In addition to the assessment required in subsection (a), a hospital shall advise a sexual assault victim of sexually transmissible diseases, hepatitis and HIV, for which postexposure prophylaxis exists, and for which deferral of treatment would either significantly reduce treatment efficacy or would pose a substantial risk to the individual's health.
(d) Upon the victim's consent, the hospital shall provide the victim with an initial dosage of up to 72 hours of postexposure prophylactic treatment for sexually transmissible diseases, hepatitis and HIV, and provide the victim with information and prescriptions necessary to obtain the remainder of the treatment regimen. A hospital will not be required to comply with this subsection when risk evaluation, adopted by the United States Department of Health and Human Services Centers for Disease Control and Prevention, clearly recommends against the application of postexposure prophylaxis.
§ 117.55. Emergency contraception informational materials.
(a) A hospital that provides sexual assault emergency services shall ensure that each member of the hospital personnel that provides the services is furnished with written informational materials about emergency contraception developed by the Department under this section.
(b) The Department will prepare the written emergency contraception informational materials and make them available to hospitals in electronic format.
§ 117.56. Information regarding payment for sexual assault emergency services.
A hospital shall inform a sexual assault victim receiving sexual assault emergency services at the hospital of the availability of known financial resources for services provided to the victim due to the sexual assault, including payments by the victim's medical insurer, if applicable, the Victim's Compensation Assistance Program administered by the Pennsylvania Commission on Crime and Delinquency, government programs, public assistance programs and programs administered by the hospital. The hospital shall provide the victim any information required to secure the services, including copies of itemized bills and medical records.
§ 117.57. Religious and moral exemptions.
In accordance with section 902(a) of the act (35 P. S. § 448.902(a)), a hospital is not required to comply with § 117.53(3) (relating to emergency contraception) if compliance would be contrary to the stated religious or moral beliefs of the hospital. If the hospital does not provide emergency contraception under this religious and moral exemption, the hospital shall do the following:
(1) Notify the Department within 30 days of the hospital's decision not to provide emergency contraception.
(i) The hospital shall address and send the written notice to the Division of Acute and Ambulatory Care.
(ii) The Department will annually publish a list of hospitals in the Pennsylvania Bulletin that have chosen not to provide emergency contraception under this section.
(2) Notify the law enforcement agencies that may transport or refer a sexual assault victim to the hospital that the hospital has elected not to provide emergency contraception. The written notice to law enforcement agencies shall be sent no later than 30 days after the hospital's decision not to provide those services.
(3) Notify the ambulance and emergency medical care and transport services that may transport or refer a sexual assault victim to the hospital that the hospital has elected not to provide emergency contraception. The written notice to ambulance and emergency medical transport and care services shall be sent no later than 30 days after the hospital's decision not to provide those services.
(4) Provide individual oral and written notice to the sexual assault victim that emergency contraception is not provided at the hospital due to the stated religious or moral beliefs of the hospital.
(5) Provide oral and written notice to the victim of the hospital's obligation to arrange for transportation for the victim in accordance with paragraph (6). Notice shall also be prominently displayed in the hospital's emergency service area.
(6) Upon request of the victim, arrange for immediate transportation for the victim, at no cost to the victim, to the closest hospital where a victim could obtain emergency contraception. If the victim's medical condition does not require further inpatient hospital services, the hospital may arrange to transport the victim to a rural health clinic, Federally-qualified health center, pharmacy or other similar location where a victim could obtain emergency contraception.
§ 117.58. Exemption for hospitals providing limited emergency services.
A hospital offering the most limited range of services and that elects to refer all emergency patients after institution of essential life-saving measures under § 117.13(3) (relating to scope of services) may elect not to provide any sexual assault emergency services. If a hospital otherwise governed by this subpart elects not to provide any sexual assault emergency services under this section, the hospital shall:
(1) Notify the Department within 30 days of the hospital's decision not to provide any sexual assault emergency services.
(i) The hospital shall address and send the written notice to the Division of Acute and Ambulatory Care.
(ii) The Department will annually publish a list of hospitals in the Pennsylvania Bulletin that have chosen not to provide any sexual assault emergency services.
(2) Notify the law enforcement agencies that may transport or refer a sexual assault victim to the hospital that the hospital has elected not to provide any sexual assault emergency services. The written notice to law enforcement agencies shall be sent no later than 30 days after the hospital's decision not to provide those services.
(3) Notify the ambulance and emergency medical care and transport services that may transport or refer a sexual assault victim to the hospital that the hospital has elected not to provide any sexual assault emergency services. The written notice to ambulance and emergency medical transport and care services shall be sent no later than 30 days after the hospital's decision not to provide those services.
(4) Provide individual oral and written notice to the sexual assault victim that sexual assault emergency services are not provided at the hospital.
(5) Provide oral and written notice to the victim of the hospital's obligation to arrange for a transfer of the victim in accordance with paragraph (6). Notice shall also be prominently displayed in the hospital's emergency service area.
(6) Upon request of the victim, arrange for the immediate transfer of the victim to the closest hospital that provides sexual assault emergency services under §§ 117.51--117.56.
[Pa.B. Doc. No. 08-170. Filed for public inspection January 25, 2008, 9:00 a.m.]
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