410 Ind. Admin. Code 26-4-1

Current through November 6, 2024
Section 410 IAC 26-4-1 - Powers and duties

Authority: IC 16-21-1-7; IC 16-21-2-2.5

Affected: IC 16-21-1; IC 16-21-2; IC 16-34; IC 25-22.5

Sec. 1.

(a) The governing body:
(1) shall function as the ultimate authority; and
(2) is responsible for the conduct and management; of the abortion clinic.
(b) If the governing body is an individual who has sole authority and responsibility for the clinic, that individual may also serve as the clinic administrator or medical director, or both, if qualified. A clinic administrator appointed by the governing body may also serve as the medical director if qualified.
(c) The governing body shall do the following:
(1) Assume responsibility for:
(A) determining;
(B) implementing; and
(C) monitoring;

policies governing the clinic's operation.

(2) Ensure that:
(A) clinic policies are followed so as to provide quality health care in a safe environment; and
(B) the clinic complies with:
(i) this article;
(ii) IC 16-21; and
(iii) IC 16-34.
(3) Review, at least every six (6) months, reports of management operations, including, but not limited to, the following:
(A) Quality assessment and improvement program.
(B) Patient services provided.
(C) Results attained.
(D) Recommendations made.
(E) Actions taken.
(F) Follow-up.
(4) Maintain documents, registers, and reports that show the following:
(A) Ownership.
(B) Compliance with local, state, and federal laws and regulations.
(C) Adherence to clinic bylaws (if applicable) and clinic policies.
(5) Approve all appointments to or contracts with medical staff.
(6) Ensure the following:
(A) Maintenance of the physical plant.
(B) That the clinic is:
(i) equipped; and
(ii) staffed;

to meet the needs of the patients.

(7) Ensure that clinic policies and procedures are:
(A) updated as needed; and
(B) reviewed at least triennially.
(8) Establish the following:
(A) A policy and procedure for communication with physicians concerning a patient emergency.
(B) A process for the following:
(i) Reporting licensed health professionals who fail to comply with state professional licensing requirements as found in IC 25-22.5.
(ii) Documenting actions against licensed health professionals who fail to comply with the clinic policies and procedures.
(iii) Reporting information that statute requires the abortion clinic to report to a state agency or law enforcement agency.
(d) If the governing body is not an individual responsible for the governing of the clinic, the governing body must do the following:
(1) Adopt bylaws and operate in compliance with the bylaws.
(2) Review the bylaws at least triennially.
(e) If the governing body is not an individual who is also serving as the medical director, the governing body shall do the following:
(1) Designate a medical director who has the responsibility for the direction of:
(A) medical;
(B) nursing; and
(C) health-related;

services to patients.

(2) Maintain a liaison with the medical director.
(f) If the governing body is not an individual who is also serving as the clinic administrator, the governing body shall do the following:
(1) Designate a clinic administrator who has the responsibility and authority to carry out the day-to-day operation of the clinic.
(2) Develop criteria, which include, but are not limited to, defining educational and experience requirements for the clinic administrator.
(3) Delineate in writing the responsibility and authority of the clinic administrator.
(4) Require the following:
(A) That the clinic administrator or a designee:
(i) attend meetings of the governing body and its committees; and
(ii) act as its representative at medical staff meetings.
(B) That the clinic administrator:
(i) designate in writing an administrative officer to serve during his or her absence; and
(ii) participate in the development and implementation of appropriate policies and programs.

410 IAC 26-4-1

Indiana State Department of Health; 410 IAC 26-4-1; filed May 11, 2006, 9:36 a.m.: 29 IR 3359; readopted filed Jul 12, 2012, 12:08 p.m.: 20120808-IR-410120196RFA
Readopted filed 9/26/2018, 2:48 p.m.: 20181024-IR-410180328RFA