(a)Who may apply for order.Application for an order of transfer for a patient may be made by the patient, by a significant other or guardian of the patient, or by the sending hospital's director or the designee thereof.
(b)Content of application.(1) Written application for an order of transfer should be made on Forms A and B in subdivisions (k)-(l) of this section. Such application shall include the following: (i) the reasons for the application, indicating how the patient is expected tobenefit from the transfer;(ii) the name and address of the applicant and the applicant's relationship to the patient;(iii) the name of the hospital where the patient currently resides and the name of the hospital to which transfer is proposed;(iv) the age of the patient;(v) the admission status of the patient;(vi) the written consent of the patient (or the patient's parent or guardian, if appropriate) or a summary of the appeal procedure and result (see paragraph [c][3] of this section); and(vii) the written consent of the receiving hospital, if application is not being made directly to the receiving hospital.(2) If the sending hospital's director or the designee thereof is the applicant, the application should additionally include the following material(i) a summary of the patient's clinical record to date;(ii) the results of all pertinent physical and laboratory examinations; and(iii) all pertinent legal documents.(3) If the receiving hospital is a State-operated psychiatric center,and the patient is under 21 years of age and is a recipient of medical assistance, the application should additionally include a certification of the need for continued inpatient treatment. Such certification shall be made on forms approved by the Office of Mental Health.(i) The certification of need, completed by the sending hospital, shall include a written attestation of the following:(a) ambulatory care resources available in the community do not meet the treatment needs of the patient;(b) proper treatment of the patient's psychiatric condition requires services on an inpatient basis under the direction of a physician; and(c) continued inpatient treatment can reasonably be expected to improve the patient's condition or prevent further regression so that the services will no longer be needed.(ii) The certification of need form shall be completed by a team of two or more individuals who are independent of the receiving hospital or related agency. Such team, which has knowledge of the individual's situation, and has competence in the diagnosis and treatment of mental illness, preferably in child psychiatry, shall include a physician.(iii) If the sending hospital applied for medical assistance on behalf of the patient, but the patient's status as a recipient of medical assistance is not confirmed at the time of transfer, the application for an order of transfer shall also include a copy of any certification of need form completed by the sending hospital during the process of applying for medical assistance.(iv) If it is determined that the transfer of a patient is necessary in order to prevent serious impairment or deterioration of the health of the patient, or to prevent immediate serious physical harm to the patient or others, the sending hospital is not required to complete a certification of need form. In such cases, the receiving hospital shall complete the certification of need form within 14 days after the patient's admission to the receiving hospital.(4) If the receiving hospital is a free-standing psychiatric hospitalother than a State-operated psychiatric center, and the sending hospital is a State-operated psychiatric center, the sending hospital shall include a certification of need in the application for an order of transfer of a patient who is under 21 years of age and is a recipient of medical assistance.(i) The certification of need shall be completed as described in subparagraphs (3)(i)-(iii) of this subdivision.(ii) If it is determined that the transfer of a patient is necessary in order to prevent serious impairment or deterioration of the health of the patient, or to prevent immediate serious physical harm to the patient or others, the sending hospital is not required to complete a certification of need form.(c)Consent of patient.(1) Voluntary and informal patients. An order of transfer may be requested for a voluntary or informal patient only with the patient's written consent.A voluntary patient who refuses to consent to a transfer may be:(i) retained as a voluntary patient;(ii) discharged, if appropriate, in accordance with a service plan prepared for the patient pursuant to section 29.15 of the Mental Hygiene Law; or(iii) converted to involuntary status and thereafter transferred, if the following conditions are satisfied: (a) the patient meets the criteria for involuntary retention;(b) the patient's best interests would be served by transfer to another hospital, based on the criteria established in paragraph (d)(1) of this section; and(c) all other requirements established in this section which are applicable to the transfer of such patient are complied with.(2) Minor voluntary patients. A voluntary patient under 18 years of age who was admitted on the patient's own application must provide written consent to the transfer. In the case of a voluntary patient under 18 years of age who was not admitted on the patient's own application, that patient's parent or guardian must provide written consent to the transfer.(3) Involuntary patients. An order of transfer may be requested for any involuntary patient. The proposed transfer shall first be discussed with the patient. No request for the transfer of an objecting patient shall be made by the sending hospital until such patient has been given an opportunity to appeal such request to the sending hospital's director.(i) Appeal. The director of the sending hospital may designate the clinical director, any unit chief or psychiatrist not of the unit where the patient receives or has received care, or any supervisor of such unit chief or psychiatrist, to hear an appeal. The patient may elect to have a person represent him or her. The appeal may be conducted informally, without adhering to the rules of evidence and record-keeping. The director or the designee thereof shall: (a) review the patient's clinical history;(b) give the patient, the Mental Hygiene Legal Service and any patient representative an opportunity to discuss the patient's objections to the transfer with the director or the designee thereof; and(c) consider the criteria for transfer described in subdivision (d) of this section and determine whether, on balance, the patient's best interests would be served by transfer to another hospital.(ii) Upon completion of the appeal, the director or the designee thereof shall inform the patient, the MHLS and any patient representative of the results. If the patient is still to be transferred, the sending hospital may request an order of transfer and shall inform the patient, the MHLS and any patient representative of the anticipated date of transfer, when known.(d)Criteria for transfer.(1) Suitability of the hospital. Transfer of a patient between hospitals shall be authorized when it is determined to be in the best interests of the patient. In making the determination of which hospital better serves the best interests of the patient, the following factors shall be considered:(i) The patient's need for continued inpatient treatment.(ii) The patient's need for services which are more readily available or which can be more effectively provided at the receiving hospital.(iii) Proximity of the sending and receiving hospitals to the patient's significant others.(iv) The ability of the sending hospital to provide adequate overall treatment of the patient, as affected by:(b) reduction or elimination of services beneficial to the patient; and(c) reduction in the number of approved beds.(v) The ability of the receiving hospital to provide adequate overall treatment of the patient, as affected by: (b) the availability of services beneficial to the patient; and(2) Suitability of the patient.(i) The patient must meet the psychiatric admissions criteria of the receiving hospital.(ii) In addition to satisfying subparagraph (i) of this paragraph, a patient to be transferred from a municipal or general hospital in New York City to a hospital operated by the Office of Mental Health must satisfy the following requirements, unless waived by the commissioner or a designee thereof:(a) the patient must not require acute psychiatric care; and(b) the patient must require, or be expected to require in the future, intermediate or long-term psychiatric care.(iii) The patient must be medically cleared.(e)Who may issue order.(1) An order of transfer may be issued by the Commissioner of Mental Health. The commissioner has also delegated this authority to the Deputy Commissioner for Operations and to the director, or in the absence of such director to the duly authorized acting director, of any hospital operated or licensed by the Office of Mental Health. Such order shall be issued on Form 19 OMH "Order of Transfer," revised and contained in subdivision (m) of this section. Application for transfer to a hospital whose director has been delegated the authority to issue orders of transfer pursuant to this paragraph should be made to that hospital's director.(2) The Commissioner of the Office of Mental Health or his/her designee shall have the authority to resolve any disagreement between the hospital directors regarding the appropriateness of issuing an order of transfer for a patient.(f)Notice of transfer.Except as provided in paragraph (h)(1) of this section, the sending hospital shall give three days or more prior written notice of transfer to the following parties:
(1) the nearest relative of the patient, other than the applicant for the patient's transfer;(2) additional significant others who the patient has indicated should receive notice of the patient's hospitalization and status;(3) the patient's guardian, if any, if such guardian has not been previously notified and is not included under paragraph (1) or (2) of this subdivision; and(4) the Mental Hygiene Legal Service.(g) Process for transfer.Transfer of a patient should cause the least possible disruption in the patient's daily living routine. The sending and receiving hospitals shall cooperate in arranging a process for transfer which accomplishes this objective. This process may be initiated in the following ways:
(1) By written application. (i) The applicant may apply in writing for an order of transfer, in accordance with this section. Upon issuance of the order, the applicant and, if necessary, the receiving hospital shall be notified and a copy of the order and the underlying application shall be forwarded to the sending hospital, to the Mental Hygiene Legal Service and, if necessary, to the receiving hospital.(ii) The sending hospital shall provide an opportunity to the receiving hospital to examine the patient prior to admission, unless such examination is waived by the receiving hospital. The examination may be conducted prior to submission of the written application for transfer. In the absence of an agreement applicable to both hospitals which provides for examination of the patient at the receiving hospital, the receiving hospital shall send a screening team to the sending hospital to directly interview the patient and meet with members of staff familiar with the patient. At the time of this screening, the sending hospital should provide copies of any material described in paragraph (b)(2) of this section which have not already been provided to the receiving hospital.(iii) The patient shall be transferred as soon as possible to the receiving hospital along with a certified copy of such patient's admission paper and case record, in accordance with the order of transfer, unless such hospital determines that the patient is inappropriate for admission. Copies of any material described in paragraph (b)(2) of this section which have not already been provided to the receiving hospital must be provided at this time.(iv) If the receiving hospital determines that the patient is not appropriate for admission, the order of transfer shall not be issued or, if already issued, may be cancelled. The sending facility shall be immediately notified, the MHLS shall be given immediate written notice, and the patient, if located at the receiving hospital, shall be returned to the sending hospital.(2) By telephone. (i) As an alternative procedure to paragraph (1) of this subdivision, the sending hospital may, at the option of the receiving hospital's director, arrange the transfer with such director or the designee thereof by telephone. The date of the transfer should be arranged at that time and confirmed one day prior to the actual transfer.(ii) A follow-up written application for an order of transfer which satisfies the requirements of this section shall be submitted at the time of the patient's examination by the receiving hospital or at the time of the patient's arrival at the receiving hospital, whichever is applicable.(iii) The sending hospital shall provide an opportunity to the receiving hospital to examine the patient prior to admission, unless such examination is waived by the receiving hospital. The examination may be conducted at either the receiving hospital or the sending hospital, as agreed upon by the two hospitals. At the examination, the sending hospital should provide copies of any material described in paragraph (b)(2) of this section.(iv) If the patient is determined to be appropriate for admission, an order of transfer shall be issued by the receiving hospital and a copy forwarded to the sending hospital and the Mental Hygiene Legal Service. The patient shall be transferred as soon as possible to the receiving hospital along with a certified copy of such patient's admission paper and case record, in accordance with the order. Copies of any material described in paragraph (b)(2) of this section which have not already been provided to the receiving hospital must be provided at this time.(v) If the receiving hospital determines that the patient is not appropriate for admission, an order of transfer shall not be issued. The sending hospital shall be immediately notified, the MHLS shall be given immediate written notice, and the patient, if located at the receiving hospital, shall be returned to the sending hospital.(h)Exceptions to process for transfer.Where inconsistent with the foregoing provisions of this section, the following paragraphs shall control:
(1) Expedited transfer of a patient who is likely to cause immediate serious physical harm. Less than three days' prior written notice of transfer may be given by the sending hospital to the parties listed in subdivision (f) of this section if the following conditions are satisfied:(i) the patient is at least 18 years of age, or the patient and the patient's parent or guardian both consent in writing to the transfer;(ii) the patient has a mental illness which is likely to result in immediate serious physical harm to self or others, as defined in section 517.3(g) of this Part, unless a specified program of services is provided to such patient; and(iii) such program of services is available at the receiving, but not the sending, hospital.(2) Transfer of an involuntary patient whose court hearing on continued retention is pending. (i)(a) The commissioner or a designee thereof may order the transfer of such patient to a hospital operated by the Office of Mental Health and such hospital's director shall be substituted for the sending hospital's director in the hearing if the commissioner or designee determines that immediate transfer would be in the best interests of the patient.(b) If the receiving OMH hospital is located outside of the county of the sending hospital and a change of venue to a court located within the county of the receiving hospital would significantly reduce inconvenience to the patient, the commissioner or designee shall direct the legal representative for the sending hospital to make arrangements with the present court for such change of venue.(ii) If clause (i)(a) of this paragraph is not applicable, the commissioner or a designee thereof shall not issue or, if already issued, shall stay an order of transfer for that patient until completion of the hearing.(3) Transfer of an involuntary patient to a residential treatment facility for children and youth. Application for transfer of such patient to a residential treatment facility for children and youth shall be reviewed by the pre-admission certification committee serving such facility in accordance with Part 583 of this Title.(i)Notice following patient's admission to receiving hospital.(1) The receiving hospital shall give written notice of the patient's admission, including the date thereof, to the Office of Mental Health and the Mental Hygiene Legal Service within three days after such admission. A copy of the admission paper need not accompany such notice.(2) The receiving hospital shall, within three days after the patient is admitted, give written notice of such admission, including the patient's admission status and rights under article 9 of the Mental Hygiene Law, to the following parties: (ii) the nearest relative of the patient, other than the applicant for the patient's transfer;(iii) additional significant others who the patient has indicated should receive notice of the patient's hospitalization and status; and(iv) the patient's guardian, if any, if such guardian is not included under subparagraph (ii) or (iii) of this paragraph.(j)Dispute resolution.Every effort should be made to resolve, in accordance with local practice not inconsistent with paragraph (e)(2) of this section, any disputes regarding the refusal to issue or the cancellation of an order of transfer by a receiving hospital. Transfer of the patient may proceed pending final resolution of the dispute, unless there is a temporary restraining order in effect which prohibits such transfer.
(k)Form A.Form A
REQUEST FOR ORDER OF TRANSFER
(Date)
I, (Name of Applicant) (Relationship to Patient)
of (Sending Hospital or Address), request the transfer of (Name of Patient),
to (Receiving Hospital), on (Voluntary or Involuntary) status.
Such transfer is expected to benefit the patient as follows:_____________________
____________________________________________________
____________________________________________________
(Please complete ONE of the following numbered statements)
1. (Name of Patient) is on Involuntary Status and does not object to being transferred to (Receiving Hospital). Please issue an Order of Transfer to............................................................ your hospital.................................................................2. (Name of Patient) is on Involuntary Status and objects to being transferred to (Receiving Hospital). A hearing was held on__,_________________________________ 19 _ in the presence of the above-titled administrator or the designee thereof. This hearing confirmed our opinion that the patient is in need of continuing psychiatric hospitalization and would benefit from treatment at (Receiving Hospital). Please issue an............................................................
Order of Transfer to your hospital..........................................................
3. (Name of Patient) is on Voluntary Status and has consented to this transfer as indicated by the patient's affixed signature below...........................................................................4. (Name of Patient) is under eighteen years of age and is on Voluntary Status and was hospitalized on the application of the patient's parent or legal guardian, who has consented to this transfer as indicated by such parent's or guardian's signature affixed below.
The following court proceedings involving this patient are pending: (Please complete if applicable)
Involuntary commitment proceeding, scheduled to be heard in __Court, located at __, on the _ day of _, 19_, at _ am/pm.
Other proceeding (description of legal proceeding) scheduled to be heard at
______ Court, located at _______, on the _day of ______, 19_, at __ am/pm.
(Please check if applicable)
[] No court proceeding involving this patient is pending.
Signature of Applicant
Signature of Patient or Representative
Telephone approval of Order of Transfer (No. __) given by
(Name of Receiving Hospital Employee) to
(Name of Sending Hospital Employee) on (Date)
at (Time).
(l)Form B.Form B
INFORMATION CHECK LIST
(Date)
We have determined that _________, a patient on Ward _ at (Sending Hospital), requires continued hospitalization, and is appropriate for
treatment at (Receiving Hospital). The following material is appended:
[] Request for Order of Transfer, including summary of the hearing procedure conducted for any involuntary patient objecting to transfer (copy to be returned to sending hospital with the signed Order of Transfer).
[] Summary of the clinical record to date. (This must provide sufficient detail to allow for assessment of the patient's appropriateness for hospitalization.)
[] All physical and laboratory examination results pertaining to the patient's treatment.
[] All legal documents pertaining to the patient's retention or transfer.
Dr. __________, who can be reached at (Telephone Number), is the
physician most familiar with the clinical profile of this patient. In accordance with existing agreements and Part 517 of the Mental Hygiene regulations, any clinical or discharge summary and any physical and laboratory examination results not appended hereto and not previously provided to the receiving hospital shall be made available to such hospital no later than the time of transfer.
Director of Sending Hospital/Designee
Telephone No.
(m)Form 19-OMH.Form 19-OMH
STATE OF NEW YORK OFFICE OF MENTAL HEALTH
ORDER OF TRANSFER
(Pursuant to section 29.11 of the Mental Hygiene Law)
(Date)
A written request to this Office having been made for the transfer of (Name of Patient),
a patient at (Sending Hospital), and the reasons for such transfer being satisfactory, and
the Mental Hygiene Legal Service having been given notice of the proposed transfer, it is hereby ordered that the director of said hospital discharge said patient for transfer to (Receiving Hospital)
and that the director of the latter hospital receive said patient for treatment upon the presentation of this original order, together with a certified copy of the original admission paper and case record.
BY THE COMMISSIONER:
(Signature)
(Print Name)
(Title)
N.Y. Comp. Codes R. & Regs. Tit. 14 § 517.4