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Statutes > Texas > Health-and-safety-code > Title-4-health-facilities > Chapter-241-hospitals

HEALTH AND SAFETY CODE

TITLE 4. HEALTH FACILITIES

SUBTITLE B. LICENSING OF HEALTH FACILITIES

CHAPTER 241. HOSPITALS

SUBCHAPTER A. GENERAL PROVISIONS

Sec. 241.001. SHORT TITLE. This chapter may be cited as the

Texas Hospital Licensing Law.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Sec. 241.002. PURPOSE. The purpose of this chapter is to

protect and promote the public health and welfare by providing

for the development, establishment, and enforcement of certain

standards in the construction, maintenance, and operation of

hospitals.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Sec. 241.003. DEFINITIONS. In this chapter:

(1) "Advanced practice nurse" means a registered nurse

recognized as an advanced practice nurse by the Texas Board of

Nursing.

(2) "Board" means the Texas Board of Health.

(3) "Comprehensive medical rehabilitation hospital" means a

general hospital that specializes in providing comprehensive

medical rehabilitation services, including surgery and related

ancillary services.

(4) "Department" means the Texas Department of Health.

(5) "General hospital" means an establishment that:

(A) offers services, facilities, and beds for use for more than

24 hours for two or more unrelated individuals requiring

diagnosis, treatment, or care for illness, injury, deformity,

abnormality, or pregnancy; and

(B) regularly maintains, at a minimum, clinical laboratory

services, diagnostic X-ray services, treatment facilities

including surgery or obstetrical care or both, and other

definitive medical or surgical treatment of similar extent.

(6) "Governmental unit" means a political subdivision of the

state, including a hospital district, county, or municipality,

and any department, division, board, or other agency of a

political subdivision.

(7) "Hospital" includes a general hospital and a special

hospital.

(8) "Medical staff" means a physician or group of physicians and

a podiatrist or a group of podiatrists who by action of the

governing body of a hospital are privileged to work in and use

the facilities of a hospital for or in connection with the

observation, care, diagnosis, or treatment of an individual who

is, or may be, suffering from a mental or physical disease or

disorder or a physical deformity or injury.

(9) "Pediatric and adolescent hospital" means a general hospital

that specializes in providing services to children and

adolescents, including surgery and related ancillary services.

(10) "Person" means an individual, firm, partnership,

corporation, association, or joint stock company, and includes a

receiver, trustee, assignee, or other similar representative of

those entities.

(11) "Physician" means a physician licensed by the Texas State

Board of Medical Examiners.

(12) "Physician assistant" means a physician assistant licensed

by the Texas State Board of Physician Assistant Examiners.

(13) "Podiatrist" means a podiatrist licensed by the Texas State

Board of Podiatric Medical Examiners.

(14) Repealed by Acts 2005, 79th Leg., Ch. 1286, Sec. 2, eff.

September 1, 2005.

(15) "Special hospital" means an establishment that:

(A) offers services, facilities, and beds for use for more than

24 hours for two or more unrelated individuals who are regularly

admitted, treated, and discharged and who require services more

intensive than room, board, personal services, and general

nursing care;

(B) has clinical laboratory facilities, diagnostic X-ray

facilities, treatment facilities, or other definitive medical

treatment;

(D) maintains records of the clinical work performed for each

patient.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Amended by Acts 1995, 74th Leg., ch. 965, Sec. 79, eff. Sept. 1,

1995; Acts 1997, 75th Leg., ch. 43, Sec. 1, eff. May 7, 1997;

Acts 1997, 75th Leg., ch. 623, Sec. 2, eff. Sept. 1, 1997; Acts

1999, 76th Leg., ch. 428, Sec. 1, eff. Sept. 1, 1999.

Amended by:

Acts 2005, 79th Leg., Ch.

1286, Sec. 2, eff. September 1, 2005.

Acts 2007, 80th Leg., R.S., Ch.

889, Sec. 67, eff. September 1, 2007.

Sec. 241.004. EXEMPTIONS. This chapter does not apply to a

facility:

(1) licensed under Chapter 242 or 577;

(2) maintained or operated by the federal government or an

agency of the federal government; or

(3) maintained or operated by this state or an agency of this

state.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Amended by Acts 1991, 72nd Leg., ch. 76, Sec. 16, eff. Sept. 1,

1991.

Sec. 241.005. EMPLOYMENT OF PERSONNEL. The department may

employ stenographers, inspectors, and other necessary assistants

in carrying out the provisions of this chapter.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Sec. 241.006. COORDINATION OF SIGNAGE REQUIREMENTS IMPOSED BY

STATE AGENCIES. (a) The department is authorized to review

current and proposed state rules issued by the department or by

other state agencies that mandate that a hospital place or post a

notice, poster, or sign in a conspicuous place or in an area of

high public traffic, concerning the rights of patients or others

or the responsibilities of the hospital, which is directed at

patients, patients' families, or others. The purpose of this

review shall be to coordinate the placement, format, and language

contained in the required notices in order to:

(1) eliminate the duplication of information;

(2) reduce the potential for confusion to patients, patients'

families, and others; and

(3) reduce the administrative burden of compliance on hospitals.

(b) Notwithstanding any other law, this section applies to all

notices, posters, or signs described in Subsection (a).

Added by Acts 1995, 74th Leg., ch. 965, Sec. 3, eff. June 16,

1995.

SUBCHAPTER B. HOSPITAL LICENSES

Sec. 241.021. LICENSE REQUIRED. A person or governmental unit,

acting severally or jointly with any other person or governmental

unit, may not establish, conduct, or maintain a hospital in this

state without a license issued under this chapter.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Sec. 241.022. LICENSE APPLICATION. (a) An application for a

license must be made to the department on a form provided by the

department.

(b) The application must contain:

(1) the name and social security number of the sole proprietor,

if the applicant is a sole proprietor;

(2) the name and social security number of each general partner

who is an individual, if the applicant is a partnership;

(3) the name and social security number of any individual who

has an ownership interest of more than 25 percent in the

corporation, if the applicant is a corporation; and

(4) any other information that the department may reasonably

require.

evidence that:

(1) at least one physician is on the medical staff of the

hospital, including evidence that the physician is currently

licensed;

(2) the governing body of the hospital has adopted and

implemented a patient transfer policy in accordance with Section

241.027; and

(3) if the governing body has chosen to implement patient

transfer agreements, it has implemented the agreements in

accordance with Section 241.028.

(d) The application must be accompanied by:

(1) a copy of the hospital's current patient transfer policy;

(2) a nonrefundable license fee;

(3) copies of the hospital's patient transfer agreements, unless

the filing of copies has been waived by the hospital licensing

director in accordance with the rules adopted under this chapter;

and

(4) a copy of the most recent annual fire safety inspection

report from the fire marshal in whose jurisdiction the hospital

is located.

(e) The department may require that the application be approved

by the local health authority or other local official for

compliance with municipal ordinances on building construction,

fire prevention, and sanitation. A hospital located outside the

limits of a municipality shall comply with corresponding state

laws.

(f) The department shall post on the department's Internet

website a list of all of the individuals named in applications as

required by Subsections (b)(1)-(3). The department may not post

on its Internet website a social security number of an individual

required to be named in an application under Subsections

(b)(1)-(3).

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Amended by Acts 1991, 72nd Leg., ch. 14, Sec. 82, eff. Sept. 1,

1991; Acts 1993, 73rd Leg., ch. 584, Sec. 1, eff. Sept. 1, 1993.

Amended by:

Acts 2005, 79th Leg., Ch.

1161, Sec. 1, eff. September 1, 2005.

Sec. 241.023. ISSUANCE OF LICENSE. (a) On receiving a license

application and the license fee, the department shall issue a

license if it finds that the applicant and the hospital comply

with this chapter and the rules or standards adopted under this

chapter.

(b) A license may be renewed annually after payment of the

required fee and submission of an application for license renewal

that contains the information required by Section 241.022(b).

issue a license only for the premises of a hospital and person or

governmental unit named in the application.

(c-1) The department may issue one license for multiple

hospitals if:

(1) all buildings in which inpatients receive hospital services

and inpatient services of each of the hospitals to be included in

the license are subject to the control and direction of the same

governing body;

(2) all buildings in which inpatients receive hospital services

are within a 30-mile radius of the main address of the applicant;

(3) there is integration of the organized medical staff of each

of the hospitals to be included in the license;

(4) there is a single chief executive officer for all of the

hospitals who reports directly to the governing body and through

whom all administrative authority flows and who exercises control

and surveillance over all administrative activities of the

hospital;

(5) there is a single chief medical officer for all of the

hospitals who reports directly to the governing body and who is

responsible for all medical staff activities of the hospital;

(6) each building of a hospital to be included in the license

that is geographically separate from other buildings of the same

hospital contains at least one nursing unit for inpatients,

unless providing only diagnostic or laboratory services, or a

combination of diagnostic or laboratory services, in the building

for hospital inpatients; and

(7) each hospital that is to be included in the license complies

with the emergency services standards:

(A) for a general hospital, if the hospital provides surgery or

obstetrical care or both; or

(B) for a special hospital, if the hospital does not provide

surgery or obstetrical care.

(c-2) The hospital licensing director may recommend a waiver of

the requirement of Subsection (c-1)(7) for a hospital if another

hospital that is to be included in the license:

(1) complies with the emergency services standards for a general

hospital; and

(2) is in close geographic proximity to the hospital.

(c-3) The executive commissioner of the Health and Human

Services Commission shall adopt rules to implement the waiver

provision of Subsection (c-2). The rules must provide for a

determination by the department that the waiver will facilitate

the creation or operation of the hospital seeking the waiver and

that the waiver is in the best interest of the individuals served

or to be served by the hospital.

(d) Subject to Subsection (e), a license issued under this

section for a hospital includes each outpatient facility that is

not separately licensed, that is located apart from the hospital,

and for which the hospital has submitted to the department:

(1) a copy of a fire safety survey that is dated not earlier

than one year before the submission date indicating approval by:

(A) the local fire authority in whose jurisdiction the

outpatient facility is located; or

(B) the nearest fire authority, if the outpatient facility is

located outside of the jurisdiction of a local fire authority;

and

(2) if the hospital is accredited by the Joint Commission on

Accreditation of Healthcare Organizations or the American

Osteopathic Association, a copy of documentation from the

accrediting body showing that the outpatient facility is included

within the hospital's accreditation.

(e) Subsection (d) applies only if the federal Department of

Health and Human Services, Health Care Financing Administration,

or Office of Inspector General adopts final or interim final

rules requiring state licensure of outpatient facilities as a

condition of the determination of provider-based status for

Medicare reimbursement purposes.

(f) A license may not be transferred or assigned without the

written approval of the department.

(g) A license shall be posted in a conspicuous place on the

licensed premises.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Amended by Acts 1999, 76th Leg., ch. 1411, Sec. 2.01, eff. Sept.

1, 1999.

Amended by:

Acts 2005, 79th Leg., Ch.

1161, Sec. 2, eff. September 1, 2005.

Acts 2005, 79th Leg., Ch.

1286, Sec. 1, eff. September 1, 2005.

Sec. 241.024. HOSPITAL LICENSING DIRECTOR. (a) The

commissioner of health shall appoint, with the advice and consent

of the board, a person to serve as hospital licensing director.

(b) A person appointed as the hospital licensing director must:

(1) have at least five years experience or training, or both, in

the field of hospital administration;

(2) be of good moral character; and

(3) have been a resident of this state for at least three years.

chapter and is directly responsible to the department.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Sec. 241.025. LICENSE FEES. (a) The department shall charge

each hospital an annual license fee for an initial license or a

license renewal.

(b) The board by rule shall adopt the fees authorized by

Subsection (a) according to a schedule under which the number of

beds in the hospital determines the amount of the fee. The fee

may not exceed $15 a bed. A minimum license fee may be

established. The minimum fee may not exceed $1,000.

estimated cost to and level of effort expended by the department

to conduct the activity for which the fee is imposed.

(d) All license fees collected shall be deposited in the state

treasury to the credit of the department to administer and

enforce this chapter. These fees are hereby appropriated to the

department.

(e) Notwithstanding Subsection (d), to the extent that money

received from the fees collected under this chapter exceeds the

costs to the department to conduct the activity for which the fee

is imposed, the department may use the money to administer

Chapter 324 and similar laws that require the department to

provide information related to hospital care to the public. The

department may not consider the costs of administering Chapter

324 or similar laws in adopting a fee imposed under this section.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Amended by Acts 1993, 73rd Leg., ch. 584, Sec. 3, eff. Sept. 1,

1993; Acts 1999, 76th Leg., ch. 1411, Sec. 2.02, eff. Sept. 1,

1999.

Amended by:

Acts 2007, 80th Leg., R.S., Ch.

997, Sec. 4, eff. September 1, 2007.

Sec. 241.026. RULES AND MINIMUM STANDARDS. (a) The board shall

adopt and enforce rules to further the purposes of this chapter.

The rules at a minimum shall address:

(1) minimum requirements for staffing by physicians and nurses;

(2) hospital services relating to patient care;

(3) fire prevention, safety, and sanitation requirements in

hospitals;

(4) patient care and a patient bill of rights;

(5) compliance with other state and federal laws affecting the

health, safety, and rights of hospital patients; and

(6) compliance with nursing peer review under Subchapter I,

Chapter 301, and Chapter 303, Occupations Code, and the rules of

the Texas Board of Nursing relating to peer review.

(b) In adopting rules, the board shall consider the conditions

of participation for certification under Title XVIII of the

Social Security Act (42 U.S.C. Section 1395 et seq.) and the

standards of the Joint Commission on Accreditation of Healthcare

Organizations and will attempt to achieve consistency with those

conditions and standards.

and the council, the board by order may waive or modify the

requirement of a particular provision of this Act or minimum

standard adopted by board rule under this section to a particular

general or special hospital if the board determines that the

waiver or modification will facilitate the creation or operation

of the hospital and that the waiver or modification is in the

best interests of the individuals served or to be served by the

hospital.

(d) The board shall adopt rules establishing procedures and

criteria for the issuance of the waiver or modification order.

The criteria must include at a minimum a statement of the

appropriateness of the waiver or modification against the best

interests of the individuals served by the hospital.

(e) If the board orders a waiver or modification of a provision

or standard, the licensing record of the hospital granted the

waiver or modification shall contain documentation to support the

board's action. The board's rules shall specify the type and

specificity of the supporting documentation that must be

included.

(f) A comprehensive medical rehabilitation hospital or a

pediatric and adolescent hospital shall have an emergency

treatment room but is not required to have an emergency

department.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Amended by Acts 1991, 72nd Leg., ch. 350, Sec. 1, eff. Aug. 26,

1991; Acts 1993, 73rd Leg., ch. 584, Sec. 4, eff. Sept. 1, 1993;

Acts 1997, 75th Leg., ch. 43, Sec. 2, eff. May 7, 1997; Acts

1997, 75th Leg., ch. 617, Sec. 2, eff. Sept. 1, 1997; Acts 1997,

75th Leg., ch. 623, Sec. 3, eff. Sept. 1, 1997; Acts 2001, 77th

Leg., ch. 1420, Sec. 14.786, eff. Sept. 1, 2001.

Amended by:

Acts 2007, 80th Leg., R.S., Ch.

889, Sec. 68, eff. September 1, 2007.

Sec. 241.0262. CIRCULATING DUTIES FOR SURGICAL SERVICES.

Circulating duties in the operating room must be performed by

qualified registered nurses. In accordance with approved medical

staff policies and procedures, licensed vocational nurses and

surgical technologists may assist in circulatory duties under the

direct supervision of a qualified registered nurse circulator.

Added by Acts 2005, 79th Leg., Ch.

966, Sec. 2, eff. September 1, 2005.

Sec. 241.0263. RECOMMENDATIONS RELATING TO MISSING INFANTS. (a)

The department shall recommend hospital security procedures to:

(1) reduce the likelihood of infant patient abduction; and

(2) aid in the identification of missing infants.

(b) In making recommendations, the department shall consider

hospital size and location and the number of births at a

hospital.

Subsection (a)(1) may include:

(1) controlling access to newborn nurseries;

(2) expanding observation of newborn nurseries through the use

of video cameras; and

(3) requiring identification for hospital staff and visitors as

a condition of entrance to newborn nurseries.

(d) The procedures recommended by the department under

Subsection (a)(2) may include:

(1) footprinting, photographing, or writing descriptions of

infant patients at birth; and

(2) obtaining umbilical cord blood samples for infant patients

born at the hospital and storing the samples for genetic testing

purposes.

(e) Each hospital licensed under this chapter shall consider

implementing the procedures recommended under this section.

Added by Acts 1997, 75th Leg., ch. 314, Sec. 1, eff. Sept. 1,

1997.

Sec. 241.0265. STANDARDS FOR CARE FOR MENTAL HEALTH AND CHEMICAL

DEPENDENCY. (a) The care and treatment of a patient receiving

mental health services in a facility licensed by the department

under this chapter or Chapter 577 are governed by the standards

adopted by the Texas Department of Mental Health and Mental

Retardation to the same extent as if the standards adopted by

that department were rules adopted by the board under this

chapter or Chapter 577.

(b) The care and treatment of a patient receiving chemical

dependency treatment in a facility licensed by the department

under this chapter are governed by the same standards that govern

the care and treatment of a patient receiving treatment in a

treatment facility licensed under Chapter 464 and that are

adopted by the Texas Commission on Alcohol and Drug Abuse, to the

same extent as if the standards adopted by the commission were

rules adopted by the board under this chapter.

Subsections (a) and (b). A violation of a standard is subject to

the same consequence as a violation of a rule adopted by the

board under this chapter or Chapter 577. The department is not

required to enforce a standard if the enforcement violates a

federal law, rule, or regulation.

Added by Acts 1993, 73rd Leg., ch. 573, Sec. 3.02, eff. Sept. 1,

1993.

Sec. 241.027. PATIENT TRANSFERS. (a) The board shall adopt

rules to govern the transfer of patients between hospitals that

do not have a transfer agreement and governing services not

included in transfer agreements.

(b) The rules must provide that patient transfers between

hospitals be accomplished through hospital policies that result

in medically appropriate transfers from physician to physician

and from hospital to hospital by providing:

(1) for notification to the receiving hospital before the

patient is transferred and confirmation by the receiving hospital

that the patient meets the receiving hospital's admissions

criteria relating to appropriate bed, physician, and other

services necessary to treat the patient;

(2) for the use of medically appropriate life support measures

that a reasonable and prudent physician exercising ordinary care

in the same or a similar locality would use to stabilize the

patient before the transfer and to sustain the patient during the

transfer;

(3) for the provision of appropriate personnel and equipment

that a reasonable and prudent physician exercising ordinary care

in the same or a similar locality would use for the transfer;

(4) for the transfer of all necessary records for continuing the

care for the patient; and

(5) that the transfer of a patient not be predicated on

arbitrary, capricious, or unreasonable discrimination because of

race, religion, national origin, age, sex, physical condition, or

economic status.

an emergency medical condition which has not been stabilized, the

hospital may not transfer the patient unless:

(1) the patient or a legally responsible person acting on the

patient's behalf, after being informed of the hospital's

obligations under this section and of the risk of transfer, in

writing requests transfer to another medical facility;

(2) a licensed physician has signed a certification, which

includes a summary of the risks and benefits, that, based on the

information available at the time of transfer, the medical

benefits reasonably expected from the provision of appropriate

medical treatment at another medical facility outweigh the

increased risks to the patient and, in the case of labor, to the

unborn child from effecting the transfer; or

(3) if a licensed physician is not physically present in the

emergency department at the time a patient is transferred, a

qualified medical person has signed a certification described in

Subdivision (2) after a licensed physician, in consultation with

the person, has made the determination described in such clause

and subsequently countersigns the certificate.

(d) The rules also shall provide that a public hospital or

hospital district shall accept the transfer of its eligible

residents if the public hospital or hospital district has

appropriate facilities, services, and staff available for

providing care to the patient.

(e) The rules must require that a hospital take all reasonable

steps to secure the informed refusal of a patient or of a person

acting on the patient's behalf to a transfer or to related

examination and treatment.

(f) The rules must recognize any contractual, statutory, or

regulatory obligations that may exist between a patient and a

designated or mandated provider as those obligations apply to the

transfer of emergency or nonemergency patients.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Amended by Acts 1991, 72nd Leg., ch. 14, Sec. 83, eff. Sept. 1,

1991; Acts 1993, 73rd Leg., ch. 584, Sec. 5, eff. Sept. 1, 1993.

Sec. 241.028. TRANSFER AGREEMENTS. (a) If hospitals execute a

transfer agreement that is consistent with the requirements of

this section, all patient transfers between the hospitals are

governed by the agreement.

(b) The hospitals shall submit the agreement to the department

for review for compliance with the requirements of this section.

The department shall complete the review of the agreement within

30 days after the date the agreement is submitted by the

hospitals.

(1) transfers be accomplished in a medically appropriate manner

and comply with Sections 241.027(b)(2) through (5) and Section

241.027(c);

(2) the transfer or receipt of patients in need of emergency

care not be based on the individual's inability to pay for the

services rendered by the transferring or receiving hospital;

(3) multiple transfer agreements be entered into by a hospital

based on the type or level of medical services available at other

hospitals;

(4) the hospitals recognize the right of an individual to

request transfer to the care of a physician and hospital of the

individual's choice;

(5) the hospitals recognize and comply with the requirements of

Chapter 61 (Indigent Health Care and Treatment Act) relating to

the transfer of patients to mandated providers; and

(6) consideration be given to availability of appropriate

facilities, services, and staff for providing care to the

patient.

(d) If a hospital transfers a patient in violation of Subsection

(c)(1), (2), (4), (5), or (6), relating to required provisions

for a transfer agreement, the violation is a violation of this

chapter.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Amended by Acts 1991, 72nd Leg., ch. 14, Sec. 84, eff. Sept. 1,

1991; Acts 1993, 73rd Leg., ch. 584, Sec. 6, eff. Sept. 1, 1993.

Sec. 241.029. POLICIES AND PROCEDURES RELATING TO WORKPLACE

SAFETY. (a) The governing body of a hospital shall adopt

policies and procedures related to the work environment for

nurses to:

(1) improve workplace safety and reduce the risk of injury,

occupational illness, and violence; and

(2) increase the use of ergonomic principles and ergonomically

designed devices to reduce injury and fatigue.

(b) The policies and procedures adopted under Subsection (a), at

a minimum, must include:

(1) evaluating new products and technology that incorporate

ergonomic principles;

(2) educating nurses in the application of ergonomic practices;

(3) conducting workplace audits to identify areas of risk of

injury, occupational illness, or violence and recommending ways

to reduce those risks;

(4) controlling access to those areas identified as having a

high risk of violence; and

(5) promptly reporting crimes committed against nurses to

appropriate law enforcement agencies.

Added by Acts 2003, 78th Leg., ch. 876, Sec. 13, eff. June 20,

2003.

SUBCHAPTER C. ENFORCEMENT

Sec. 241.051. INSPECTIONS. (a) The department may make any

inspection, survey, or investigation that it considers necessary.

A representative of the department may enter the premises of a

hospital at any reasonable time to make an inspection, a survey,

or an investigation to assure compliance with or prevent a

violation of this chapter, the rules adopted under this chapter,

an order or special order of the commissioner of health, a

special license provision, a court order granting injunctive

relief, or other enforcement procedures. The department shall

maintain the confidentiality of hospital records as applicable

under state or federal law.

(b) The department or a representative of the department is

entitled to access to all books, records, or other documents

maintained by or on behalf of the hospital to the extent

necessary to enforce this chapter, the rules adopted under this

chapter, an order or special order of the commissioner of health,

a special license provision, a court order granting injunctive

relief, or other enforcement procedures.

consents to entry and inspection of the hospital by the

department or a representative of the department in accordance

with this chapter and the rules adopted under this chapter.

(d) All information and materials obtained or compiled by the

department in connection with a complaint and investigation

concerning a hospital are confidential and not subject to

disclosure under Section 552.001 et seq., Government Code, and

not subject to disclosure, discovery, subpoena, or other means of

legal compulsion for their release to anyone other than the

department or its employees or agents involved in the enforcement

action except that this information may be disclosed to:

(1) persons involved with the department in the enforcement

action against the hospital;

(2) the hospital that is the subject of the enforcement action,

or the hospital's authorized representative;

(3) appropriate state or federal agencies that are authorized to

inspect, survey, or investigate hospital services;

(4) law enforcement agencies; and

(5) persons engaged in bona fide research, if all

individual-identifying and hospital-identifying information has

been deleted.

(e) The following information is subject to disclosure in

accordance with Section 552.001 et seq., Government Code:

(1) a notice of alleged violation against the hospital, which

notice shall include the provisions of law which the hospital is

alleged to have violated, and a general statement of the nature

of the alleged violation;

(2) the pleadings in the administrative proceeding; and

(3) a final decision or order by the department.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Amended by Acts 1993, 73rd Leg., ch. 584, Sec. 8, eff. Sept. 1,

1993; Acts 1999, 76th Leg., ch. 1444, Sec. 15, eff. Aug. 30,

1999.

Sec. 241.052. COMPLIANCE WITH RULES AND STANDARDS. (a) A

hospital that is in operation when an applicable rule or minimum

standard is adopted under this chapter must be given a reasonable

period within which to comply with the rule or standard.

(b) The period for compliance may not exceed six months, except

that the department may extend the period beyond six months if

the hospital sufficiently shows the department that it requires

additional time to complete compliance with the rule or standard.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Sec. 241.053. DENIAL OF APPLICATION, SUSPENSION, REVOCATION,

PROBATION, OR REISSUANCE OF LICENSE. (a) The department, after

providing notice and an opportunity for a hearing to the

applicant or license holder, may deny, suspend, or revoke a

hospital's license if the department finds that the hospital:

(1) failed to comply with:

(A) a provision of this chapter;

(B) a rule adopted under this chapter;

(D) an order or emergency order by the commissioner of health;

(E) another enforcement procedure permitted under this chapter;

(2) has a history of noncompliance with the rules adopted under

this chapter relating to patient health, safety, and rights which

reflects more than nominal noncompliance; or

(3) has aided, abetted, or permitted the commission of an

illegal act.

(b) A hospital whose license is suspended or revoked may apply

to the department for the reissuance of a license. The department

may reissue the license if the department determines that the

hospital has corrected the conditions that led to the suspension

or revocation of the hospital's license, the initiation of

enforcement action against the hospital, the assessment of

administrative penalties, or the issuance of a court order

enjoining the hospital from violations or assessing civil

penalties against the hospital. A hospital whose license is

suspended or revoked may not admit new patients until the license

is reissued.

required in the rules adopted under this chapter.

(d) Administrative hearings required under this section shall be

conducted under the board's formal hearing rules and the

contested case provisions of Chapter 2001, Government Code.

(e) Judicial review of a final decision by the department is by

trial de novo in the same manner as a case appealed from the

justice court to the county court. The substantial evidence rule

does not apply.

(f) If the department finds that a hospital is in repeated

noncompliance under Subsection (a) but that the noncompliance

does not endanger public health and safety, the department may

schedule the hospital for probation rather than suspending or

revoking the hospital's license. The department shall provide

notice to the hospital of the probation and of the items of

noncompliance not later than the 10th day before the date the

probation period begins. The department shall designate a period

of not less than 30 days during which the hospital will remain

under probation. During the probation period, the hospital must

correct the items that were in noncompliance and report the

corrections to the department for approval.

(g) The department may suspend or revoke the license of a

hospital that does not correct items that were in noncompliance

or that does not comply with the applicable requirements within

the applicable probation period.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Amended by Acts 1993, 73rd Leg., ch. 584, Sec. 9, eff. Sept. 1,

1993; Acts 1993, 73rd Leg., ch. 705, Sec. 3.01, eff. Sept. 1,

1993; Acts 1995, 74th Leg., ch. 76, Sec. 5.95(51), eff. Sept. 1,

1995; Acts 2003, 78th Leg., ch. 802, Sec. 1, 2, eff. June 20,

2003.

Sec. 241.0531. COMMISSIONER'S EMERGENCY ORDERS. (a) Following

notice to the hospital and opportunity for hearing, the

commissioner of health or a person designated by the commissioner

may issue an emergency order, either mandatory or prohibitory in

nature, in relation to the operation of a hospital licensed under

this chapter if the commissioner or the commissioner's designee

determines that the hospital is violating or threatening to

violate this chapter, a rule adopted pursuant to this chapter, a

special license provision, injunctive relief issued pursuant to

Section 241.054, an order of the commissioner or the

commissioner's designee, or another enforcement procedure

permitted under this chapter and the provision, rule, license

provision, injunctive relief, order, or enforcement procedure

relates to the health or safety of the hospital's patients.

(b) The department shall send written notice of the hearing and

shall include within the notice the time and place of the

hearing. The hearing must be held within 10 days after the date

of the hospital's receipt of the notice.

provisions of Chapter 2001, Government Code but shall instead be

held in accordance with the board's informal hearing rules.

(d) The order shall be effective on delivery to the hospital or

at a later date specified in the order.

Added by Acts 1993, 73rd Leg., ch. 584, Sec. 10, eff. Sept. 1,

1993. Amended by Acts 1995, 74th Leg., ch. 76, Sec. 5.95(51),

eff. Sept. 1, 1995.

Sec. 241.054. VIOLATIONS; INJUNCTIONS. (a) The department

shall:

(1) notify a hospital of a finding by the department that the

hospital is violating or has violated this chapter or a rule or

standard adopted under this chapter; and

(2) provide the hospital an opportunity to correct the

violation.

(b) After the notice and opportunity to comply, the commissioner

of health may request the attorney general or the appropriate

district or county attorney to institute and conduct a suit for a

violation of this chapter or a rule adopted under this chapter.

restraining order to restrain a continuing violation if the

department finds that the violation creates an immediate threat

to the health and safety of the patients of a hospital.

(d) On his own initiative, the attorney general, a district

attorney, or a county attorney may maintain an action in the name

of the state for a violation of this chapter or a rule adopted

under this chapter.

(e) The district court shall assess the civil penalty authorized

by Section 241.055, grant injunctive relief, or both, as

warranted by the facts. The injunctive relief may include any

prohibitory or mandatory injunction warranted by the facts,

including a temporary restraining order, temporary injunction, or

permanent injunction.

(f) The department and the party bringing the suit may recover

reasonable expenses incurred in obtaining injunctive relief,

civil penalties, or both, including investigation costs, court

costs, reasonable attorney fees, witness fees, and deposition

expenses.

(g) Venue may be maintained in Travis County or in the county in

which the violation occurred.

(h) Not later than the seventh day before the date on which the

attorney general intends to bring suit on his own initiative, the

attorney general shall provide to the department notice of the

suit. The attorney general is not required to provide notice of a

suit if the attorney general determines that waiting to bring

suit until the notice is provided will create an immediate threat

to the health and safety of a patient. This section does not

create a requirement that the attorney general obtain the

permission of a referral from the department before filing suit.

(i) The injunctive relief and civil penalty authorized by this

section and Section 241.055 are in addition to any other civil,

administrative, or criminal penalty provided by law.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Amended by Acts 1993, 73rd Leg., ch. 705, Sec. 3.02, eff. Sept.

1, 1993.

Sec. 241.055. CIVIL PENALTY. (a) A hospital shall timely

adopt, implement, and enforce a patient transfer policy in

accordance with Section 241.027. A hospital may implement patient

transfer agreements in accordance with Section 241.028.

(b) A hospital that violates Subsection (a), another provision

of this chapter, or a rule adopted or enforced under this chapter

is liable for a civil penalty of not more than $1,000 for each

day of violation and for each act of violation. A hospital that

violates this chapter or a rule or order adopted under this

chapter relating to the provision of mental health, chemical

dependency, or rehabilitation services is liable for a civil

penalty of not more than $25,000 for each day of violation and

for each act of violation.

shall consider:

(1) the hospital's previous violations;

(2) the seriousness of the violation, including the nature,

circumstances, extent, and gravity of the violation;

(3) whether the health and safety of the public was threatened

by the violation;

(4) the demonstrated good faith of the hospital; and

(5) the amount necessary to deter future violations.

(d) A penalty collected under this section by the attorney

general shall be deposited to the credit of the general revenue

fund. A penalty collected under this section by a district or

county attorney shall be deposited to the credit of the general

fund of the county in which the suit was heard.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Amended by Acts 1991, 72nd Leg., ch. 14, Sec. 86, eff. Sept. 1,

1991; Acts 1993, 73rd Leg., ch. 584, Sec. 11, eff. Sept. 1, 1993;

Acts 1993, 73rd Leg., ch. 705, Sec. 3.03, eff. Sept. 1, 1993.

Sec. 241.056. SUIT BY PERSON HARMED. (a) A person who is

harmed by a violation under Section 241.028 or 241.055 may

petition a district court for appropriate injunctive relief.

(b) Venue for a suit brought under this section is in the county

in which the person resides or, if the person is not a resident

of this state, in Travis County.

common law.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Amended by Acts 1991, 72nd Leg., ch. 14, Sec. 87, eff. Sept. 1,

1991; Acts 1993, 73rd Leg., ch. 584, Sec. 12, eff. Sept. 1, 1993.

Sec. 241.057. CRIMINAL PENALTY. (a) A person commits an

offense if the person establishes, conducts, manages, or operates

a hospital without a license.

(b) An offense under this section is a misdemeanor punishable by

a fine of not more than $100 for the first offense and not more

than $200 for each subsequent offense.

offense.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Sec. 241.058. MINOR VIOLATIONS. (a) This chapter does not

require the commissioner of health or a designee of the

commissioner to report a minor violation for prosecution or the

institution of any other enforcement proceeding authorized under

this chapter, if the commissioner or a designee of the

commissioner determines that prosecution or enforcement is not in

the best interests of the persons served or to be served by the

hospital.

(b) For the purpose of this section, a "minor violation" means a

violation of this chapter, the rules adopted under this chapter,

a special license provision, an order or emergency order issued

by the commissioner of health or the commissioner's designee, or

another enforcement procedure permitted under this chapter by a

hospital that does not constitute a threat to the health, safety,

and rights of the hospital's patients or other persons.

Added by Acts 1993, 73rd Leg., ch. 584, Sec. 13, eff. Sept.

1,1993.

Sec. 241.0585. RECOVERY OF COSTS. If the attorney general

brings an action to enforce an administrative penalty assessed

under Section 241.058 and the court orders the payment of the

penalty, the attorney general may recover reasonable expenses

incurred in the investigation, initiation, or prosecution of the

enforcement suit, including investigative costs, court costs,

reasonable attorney fees, witness fees, and deposition expenses.

Added by Acts 1993, 73rd Leg., ch. 705, Sec. 3.041, eff. Sept. 1,

1993.

Sec. 241.059. ADMINISTRATIVE PENALTY. (a) The commissioner of

health may assess an administrative penalty against a hospital

that violates this chapter, a rule adopted pursuant to this

chapter, a special license provision, an order or emergency order

issued by the commissioner or the commissioner's designee, or

another enforcement procedure permitted under this chapter. The

commissioner shall assess an administrative penalty against a

hospital that violates Section 166.004.

(b) In determining the amount of the penalty, the commissioner

of health shall consider:

(1) the hospital's previous violations;

(2) the seriousness of the violation;

(3) any threat to the health, safety, or rights of the

hospital's patients;

(4) the demonstrated good faith of the hospital; and

(5) such other matters as justice may require.

that the penalty for a violation of Section 166.004 shall be

$500. Each day of a continuing violation, other than a violation

of Section 166.004, may be considered a separate violation.

(d) When it is determined that a violation has occurred the

commissioner of health shall issue a report that states the facts

on which the determination is based and the commissioner's

recommendation on the imposition of a penalty, including a

recommendation on the amount of the penalty.

(e) Within 14 days after the date the report is issued, the

commissioner of health shall give written notice of the report to

the person, delivered by certified mail. The notice must include

a brief summary of the alleged violation and a statement of the

amount of the recommended penalty and must inform the person that

the person has a right to a hearing on the occurrence of the

violation, the amount of the penalty, or both the occurrence of

the violation and the amount of the penalty.

(f) Within 20 days after the date the person receives the

notice, the person in writing may accept the determination and

recommended penalty of the commissioner of health or may make a

written request for a hearing on the occurrence of the violation,

the amount of the penalty, or both the occurrence of the

violation and the amount of the penalty.

(g) If the person accepts the determination and recommended

penalty of the commissioner of health, the commissioner by order

shall impose the recommended penalty.

(h) If the person requests a hearing or fails to respond timely

to the notice, the commissioner of health shall set a hearing and

give notice of the hearing to the person. The hearing shall be

held by the department. The person conducting the hearing shall

make findings of fact and conclusions of law and promptly issue

to the commissioner a proposal for a decision about the

occurrence of the violation and the amount of the penalty. Based

on the findings of fact, conclusions of law, and proposal for a

decision, the commissioner by order may find that a violation has

occurred and impose a penalty or may find that no violation

occurred.

(i) The notice of the commissioner of health's order given to

the person under Chapter 2001, Government Code must include a

statement of the right of the person to judicial review of the

order.

(j) Within 30 days after the date the commissioner of health's

order is final as provided by Subchapter F, Chapter 2001,

Government Code, the person shall:

(1) pay the amount of the penalty;

(2) pay the amount of the penalty and file a petition for

judicial review contesting the occurrence of the violation, the

amount of the penalty, or both the occurrence of the violation

and the amount of the penalty; or

(3) without paying the amount of the penalty, file a petition

for judicial review contesting the occurrence of the violation,

the amount of the penalty, or both the occurrence of the

violation and the amount of the penalty.

(k) Within the 30-day period, a person who acts under Subsection

(j)(3) may:

(1) stay enforcement of the penalty by:

(A) paying the amount of the penalty to the court for placement

in an escrow account; or

(B) giving to the court a supersedeas bond that is approved by

the court for the amount of the penalty and that is effective

until all judicial review of the board's order is final; or

(2) request the court to stay enforcement of the penalty by:

(A) filing with the court a sworn affidavit of the person

stating that the person is financially unable to pay the amount

of the penalty and is financially unable to give the supersedeas

bond; and

(B) giving a copy of the affidavit to the commissioner of health

by certified mail.

(l) When the commissioner of health receives a copy of an

affidavit under Subsection (k)(2), he may file with the court,

within five days after the date the copy is received, a contest

to the affidavit. The court shall hold a hearing on the facts

alleged in the affidavit as soon as practicable and shall stay

the enforcement of the penalty on finding that the alleged facts

are true. The person who files an affidavit has the burden of

proving that the person is financially unable to pay the amount

of the penalty and to give a supersedeas bond.

(m) If the person does not pay the amount of the penalty and the

enforcement of the penalty is not stayed, the commissioner of

health may refer the matter to the attorney general for

collection of the amount of the penalty.

(n) Judicial review of the order of the commissioner of health:

(1) is instituted by filing a petition as provided by Subchapter

G, Chapter 2001, Government Code; and

(2) is under the substantial evidence rule.

(o) If the court sustains the occurrence of the violation, the

court may uphold or reduce the amount of the penalty and order

the person to pay the full or reduced amount of the penalty. If

the court does not sustain the occurrence of the violation, the

court shall order that no penalty is owed.

(p) When the judgment of the court becomes final, the court

shall proceed under this subsection. If the person paid the

amount of the penalty and if that amount is reduced or is not

upheld by the court, the court shall order that the appropriate

amount plus accrued interest be remitted to the person within 30

days after the judgment of the court becomes final. The rate of

the interest is the rate charged on loans to depository

institutions by the New York Federal Reserve Bank, and the

interest shall be paid for the period beginning on the date the

penalty was paid and ending on the date the penalty is remitted.

If the person gave a supersedeas bond and if the amount of the

penalty is not upheld by the court, the court shall order the

release of the bond. If the person gave a supersedeas bond and if

the amount of the penalty is reduced, the court shall order the

release of the bond after the person pays the amount.

(q) A penalty collected under this section shall be remitted to

the comptroller for deposit in the general revenue fund.

(r) All proceedings under this section are subject to Chapter

2001, Government Code.

Added by Acts 1993, 73rd Leg., ch. 584, Sec. 14, eff. Sept. 1,

1993. Amended by Acts 1995, 74th Leg., ch. 76, Sec. 5.95(51),

(53), (55), (60), eff. Sept. 1, 1995; Acts 1999, 76th Leg., ch.

450, Sec. 2.03, eff. Sept. 1, 1999.

Sec. 241.060. ADMINISTRATIVE PENALTY FOR MENTAL HEALTH, CHEMICAL

DEPENDENCY, OR REHABILITATION SERVICES. (a) The board may

impose an administrative penalty against a person licensed or

regulated under this chapter who violates this chapter or a rule

or order adopted under this chapter relating to the provision of

mental health, chemical dependency, or rehabilitation services.

(b) The penalty for a violation may be in an amount not to

exceed $25,000. Each day a violation continues or occurs is a

separate violation for purposes of imposing a penalty.

(1) the seriousness of the violation, including the nature,

circumstances, extent, and gravity of any prohibited acts, and

the hazard or potential hazard created to the health, safety, or

economic welfare of the public;

(2) enforcement costs relating to the violation;

(3) the history of previous violations;

(4) the amount necessary to deter future violations;

(5) efforts to correct the violation; and

(6) any other matter that justice may require.

(d) If the commissioner determines that a violation has

occurred, the commissioner may issue to the board a report that

states the facts on which the determination is based and the

commissioner's recommendation on the imposition of a penalty,

including a recommendation on the amount of the penalty.

(e) Within 14 days after the date the report is issued, the

commissioner shall give written notice of the report to the

person. The notice may be given by certified mail. The notice

must include a brief summary of the alleged violation and a

statement of the amount of the recommended penalty and must

inform the person that the person has a right to a hearing on the

occurrence of the violation, the amount of the penalty, or both

the occurrence of the violation and the amount of the penalty.

(f) Within 20 days after the date the person receives the

notice, the person in writing may accept the determination and

recommended penalty of the commissioner or may make a written

request for a hearing on the occurrence of the violation, the

amount of the penalty, or both the occurrence of the violation

and the amount of the penalty.

(g) If the person accepts the determination and recommended

penalty of the commissioner, the board by order shall approve the

determination and impose the recommended penalty.

(h) If the person requests a hearing or fails to respond timely

to the notice, the commissioner shall set a hearing and give

notice of the hearing to the person. The administrative law judge

shall make findings of fact and conclusions of law and promptly

issue to the board a proposal for a decision about the occurrence

of the violation and the amount of a proposed penalty. Based on

the findings of fact, conclusions of law, and proposal for a

decision, the board by order may find that a violation has

occurred and impose a penalty or may find that no violation

occurred.

(i) The notice of the board's order given to the person under

Chapter 2001, Government Code must include a statement of the

right of the person to judicial review of the order.

(j) Within 30 days after the date the board's order is final as

provided by Subchapter F, Chapter 2001, Government Code, the

person shall:

(1) pay the amount of the penalty;

(2) pay the amount of the penalty and file a petition for

judicial review contesting the occurrence of the violation, the

amount of the penalty, or both the occurrence of the violation

and the amount of the penalty; or

(3) without paying the amount of the penalty, file a petition

for judicial review contesting the occurrence of the violation,

the amount of the penalty, or both the occurrence of the

violation and the amount of the penalty.

(k) Within the 30-day period, a person who acts under Subsection

(j)(3) may:

(1) stay enforcement of the penalty by:

(A) paying the amount of the penalty to the court for placement

in an escrow account; or

(B) giving to the court a supersedeas bond that is approved by

the court for the amount of the penalty and that is effective

until all judicial review of the board's order is final; or

(2) request the court to stay enforcement of the penalty by:

(A) filing with the court a sworn affidavit of the person

stating that the person is financially unable to pay the amount

of the penalty and is financially unable to give the supersedeas

bond; and

(B) giving a copy of the affidavit to the commissioner by

certified mail.

(l) The commissioner on receipt of a copy of an affidavit under

Subsection (k)(2) may file with the court within five days after

the date the copy is received a contest to the affidavit. The

court shall hold a hearing on the facts alleged in the affidavit

as soon as practicable and shall stay the enforcement of the

penalty on finding that the alleged facts are true. The person

who files an affidavit has the burden of proving that the person

is financially unable to pay the amount of the penalty and to

give a supersedeas bond.

(m) If the person does not pay the amount of the penalty and the

enforcement of the penalty is not stayed, the commissioner may

refer the matter to the attorney general for collection of the

amount of the penalty.

(n) Judicial review of the order of the board:

(1) is instituted by filing a petition as provided by Subchapter

G, Chapter 2001, Government Code; and

(2) is under the substantial evidence rule.

(o) If the court sustains the occurrence of the violation, the

court may uphold or reduce the amount of the penalty and order

the person to pay the full or reduced amount of the penalty. If

the court does not sustain the occurrence of the violation, the

court shall order that no penalty is owed.

(p) When the judgment of the court becomes final, the court

shall proceed under this subsection. If the person paid the

amount of the penalty and if that amount is reduced or is not

upheld by the court, the court shall order that the appropriate

amount plus accrued interest be remitted to the person. The rate

of the interest is the rate charged on loans to depository

institutions by the New York Federal Reserve Bank, and the

interest shall be paid for the period beginning on the date the

penalty was paid and ending on the date the penalty is remitted.

If the person gave a supersedeas bond and if the amount of the

penalty is not upheld by the court, the court shall order the

release of the bond. If the person gave a supersedeas bond and if

the amount of the penalty is reduced, the court shall order the

release of the bond after the person pays the amount.

(q) A penalty collected under this section shall be remitted to

the comptroller for deposit in the general revenue fund.

(r) All proceedings under this section are subject to Chapter

2001, Government Code.

Added by Acts 1993, 73rd Leg., ch. 705, Sec. 3.04, eff. Sept. 1,

1993. Amended by Acts 1995, 74th Leg., ch. 76, Sec. 5.95(49),

(53), (59), eff. Sept. 1, 1995. Renumbered from Health &

Safety Code Sec. 241.058 by Acts 1995, 74th Leg., ch. 76, Sec.

17.01(22), eff. Sept. 1, 1995.

SUBCHAPTER E. STAFF, RECORDS, AND PLAN REVIEWS

Sec. 241.101. HOSPITAL AUTHORITY CONCERNING MEDICAL STAFF. (a)

Except as otherwise provided by this section and Section 241.102,

this chapter does not change the authority of the governing body

of a hospital, as it considers necessary or advisable, to:

(1) make rules, standards, or qualifications for medical staff

membership; or

(2) grant or refuse to grant membership on the medical staff.

(b) This chapter does not prevent the governing body of a

hospital from adopting reasonable rules and requirements in

compliance with this chapter relating to:

(1) qualifications for any category of medical staff

appointments;

(2) termination of appointments; or

(3) the delineation or curtailment of clinical privileges of

those who are appointed to the medical staff.

membership and privileges or the renewal, modification, or

revocation of medical staff membership and privileges must afford

each physician, podiatrist, and dentist procedural due process

that meets the requirements of 42 U.S.C. Section 11101 et seq.,

as amended.

(d) If a hospital's credentials committee has failed to take

action on a completed application as required by Subsection (k),

or a physician, podiatrist, or dentist is subject to a

professional review action that may adversely affect his medical

staff membership or privileges, and the physician, podiatrist, or

dentist believes that mediation of the dispute is desirable, the

physician, podiatrist, or dentist may require the hospital to

participate in mediation as provided in Chapter 154, Civil

Practice and Remedies Code. The mediation shall