P.R. Laws tit. 24, § 6155s
When a mental health patient receiving at an institutional provider is in imminent danger due to a physical condition, such patient shall be transferred to a general hospital and notice shall be given to the closest family member or legal guardian not later than twenty-four (24) hours thereafter.
Likewise, hospital institutions shall adopt a “Patient Transfer Protocol”, which shall predicate, at the very least, on the following management guidelines:
(a) If a patient that is hospitalized in a psychiatric institution should experience a complication in his/her health condition due to a physical condition that might place his/her life in jeopardy:
(1) A call shall be placed to the physician of the emergency room of the general hospital selected for transfer.
(2) Such physician shall be briefed on the case and the details of the patient’s condition.
(3) The patient’s transfer shall be coordinated with the emergency room of the general hospital.
(4) A record containing relevant information on the condition, treatment offered during the emergency situation, and recommendations to manage the psychiatric condition shall be sent together with the patient, pursuant to the provisions of §§ 3111 et seq. of this title and the Emergency Medical Treatment and Active Labor Act (42 U.S.C. 1395; 42 C.F.R. § 489.24, EMTALA). Furthermore, the name and information of the physician to be contacted at the facility for the corresponding clinical follow-up shall be forwarded in writing.
(5) Upon reaching the general hospital, a screening and an evaluation shall be conducted on the patient pursuant to the provisions of §§ 3111 et seq. of this title and the EMTALA, including the pertinent studies to establish diagnosis.
(6) The patient shall be stabilized as per his/her physical condition.
(7) If the patient is not placed in the general hospital and upon having controlled his/her physical issue, such patient shall be referred to a psychiatric hospital by presenting his/her medical case for the evaluation of the latter. Such referral shall include the progress notes, the transfer notes, a summary of results, and clear instructions for follow-up after discharge, as the case may dictate.
(8) The transfer of the patient shall be coordinated with the psychiatric hospital, which shall be responsible for reevaluating the recommendations remitted by the personnel of the emergency room that serviced the patient.
(b) If a patient that is hospitalized at a general institution or at an emergency room should present an emotional disturbance:
(1) A screening and an evaluation shall be conducted on the patient pursuant to the provisions of §§ 3111 et seq. of this title and the EMTALA, including the pertinent studies to establish diagnosis.
(2) Organic origins shall be ruled out from the patient’s picture before remitting the psychiatric diagnosis.
(3) During the evaluation, the general hospital shall resolve to take into account and rule out an organic-based etiology of the symptoms present in the occurrence of the emergency which may be causing agitation in the patient.
(4) The general hospital personnel shall consult with a mental healthcare professional in seeking to establish an ongoing care plan and to obtain the authorization from relatives or the person authorized for the transfer.
(5) The patient shall be stabilized as per his/her physical condition or disturbance. The waiting time required shall depend on the evaluation for organic conditions conducted in connection with the patient’s overall health. In cases of poisoning, the general hospital shall be responsible for contacting the Poisoning Center to obtain information from this dependency as to the time it takes to eliminate the potentially toxic agent ingested from the body. Such lapse shall be the minimum period of retention for the patient at the emergency room before being transferred to the psychiatric hospital.
(6) Upon stabilization of the physical condition of the patient, such patient shall be transferred to the psychiatric hospital and a record remitted which shall provide a summary of the measures taken, a summary of the results in the form of clear follow-up instructions befitting the case, and the information of the physician that serviced the patient.
(7) The general hospital’s physician shall be responsible for contacting the psychiatric hospital chosen for transfer over the phone in seeking to provide a briefing on the case and the symptoms of the condition afflicting the patient. Likewise, coordination shall be established for the transfer of the patient to the psychiatric hospital.
(8) The psychiatric hospital shall commit itself to accepting the patient’s transfer and to service such patient.
In the event that the person has financial resources, including coverage under a health insurance plan to defray transportation expenses, such expenses shall be defrayed by the patient or by his/her health plan coverage. In such cases, the health insurance plan shall be responsible for making the payment to refund the hospital directly if such hospital institution paid for these services. In the case of persons receiving mental healthcare services under the Health Reform, the entity contracted to manage and coordinate healthcare services shall be responsible for defraying transportation expenses. If necessary, and in default of any other options, transportation shall be provided by ambulances serving under the 911 Emergency Hotline. Transportation shall cover from the place where the person who needs services is located to any other institutional provider of the hospital services needed. Ambulance transportation shall meet the requirements set forth under §§ 3111 et seq. of this title and the EMTALA.
Both the general hospital and the psychiatric hospital shall comply with all EMTALA regulations as to procedures established for the drafting and preparation of the Patient Transfer Protocol hereby mandated and required.
History —Oct. 2, 2000, No. 408, § 4.20; Aug. 6, 2008, No. 183, § 31.