Chapter 5. Health-Care and Community Residence Facility, Hospice and Home Care Licensure.
Subchapter I. Licensure.
§ 44–501. Definitions.
(a) For the purposes of this subchapter the term:
(1) "Ambulatory surgery" means a surgical procedure performed in an ambulatory surgical facility requiring a period of post-operative observation of less than 24 hours and not requiring admission to a hospital following the procedure.
(1A) "Ambulatory surgical facility" means any facility, other than a hospital, dental office, or maternity center, but including an office-based facility, a physician outpatient surgery center, or a surgical facility connected to but physically separated from a hospital, at which ambulatory surgery is performed in either an operating room or procedure room.
(2) "Assisted living residence" shall have the same meaning as provided in § 44-102.01(4).
(3) "Community residence facility" means a facility that provides a sheltered living environment for individuals who desire or need such an environment because of their physical, mental, familial, social, or other circumstances, and who are not in the custody of the Department of Corrections. All residents of a community residence facility shall be 18 years of age or older, except that, in the case of group homes for persons with intellectual disabilities, no minimum age shall apply, unless this requirement is waived in accordance with [§ 44-505(e)].
(4) "Group home for persons with intellectual disabilities" means a community residence facility that provides a home-like environment for at least 4 but no more than 8 related or unrelated individuals who on account of intellectual disabilities require specialized living arrangements, and maintains the necessary staff, programs, support services, and equipment for their care and habilitation.
(5) "Health professional" means a person licensed, registered, certified, or permitted to practice a health occupation regulated by a licensing board in the District of Columbia.
(6) "Health professional's employer" means any entity, including a facility, agency, assisted living residence, private office, health care provider, or group home, in the District of Columbia, that employs health professionals or utilizes the services of a health professional who is contracted with a third party or is self-employed, including those engaged in the practice of pharmacy.
(7) "Home care agency" means an agency, organization, or distinct part thereof, other than a hospice, that directly provides skilled nursing services and at least one other therapeutic service to an individual, in his or her home or in a community residence facility, who is sick or who has a disability.
(8) "Hospice" means an agency, organization, facility, or distinct part thereof, primarily engaged in providing a program of in-home, outpatient, or inpatient medical, nursing, counseling, bereavement, and other palliative and supportive services to terminally ill individuals and their families.
(9) "Hospital" means a facility that provides 24-hour inpatient care, including diagnostic, therapeutic, and other health-related services, for a variety of physical or mental conditions, and may in addition provide outpatient services, particularly emergency care.
(10) "Maternity center" means a facility or other place, other than a hospital or the mother's home, that provides antepartal, intrapartal, and postpartal care for both mother and child during and after normal, uncomplicated pregnancy.
(11) "Nursing home" means a 24-hour inpatient facility, or distinct part thereof, primarily engaged in providing professional nursing services, health-related services, and other supportive services needed by the patient/resident.
(11A) "Operating room" means a sterile room in a surgical suite that is designated and equipped for performing surgical operations or other invasive procedures that require a high level of asepsis control.
(11B) "Procedure room" means a non-sterile room in which minor surgical procedures are performed.
(12) "Professional incompetence" means a health professional's unfitness to continue in the health professional's profession, or to provide one or more services ordinarily provided as part of the profession, as demonstrated by:
(A) A lack of knowledge, skill, or judgment; or
(B) Disregard for the welfare of a patient or client.
(13) "Renal dialysis facility" means any place, other than a hospital or the patient's home, that provides therapeutic care for persons with acute or chronic renal failure through the use of hemodialysis, peritoneal dialysis, or any other therapy that clears the blood of substances normally excreted by the kidneys.
(13A)(A) "Surgery" means the treatment or diagnosis of disease, injury, or other disorders by direct physical intervention involving:
[(i)] Any instruments causing localized alteration or transposition of live human tissue, including lasers, ultrasound, ionizing radiation, scalpels, probes, metal knives, light knives, and needles;
(ii) Injection of diagnostic or therapeutic substances into body cavities, internal organs, joints, sensory organs, and the central nervous system; or
(iii) The cutting, burning, vaporization, freezing, suturing, probing, or manipulation of tissue by closed reductions for major dislocations or fractures, or otherwise altering tissue by mechanical, thermal, light-based, electromagnetic, or chemical means.
(B) The term "surgery" does not include:
(i) The administration of subcutaneous, intramuscular or intravenous injections by an authorized health professional;
(ii) Topical treatments; or
(iii) Generally non-invasive procedures which do not require an aseptic surgical field.
(14) "Therapeutic service" includes physical, speech, or occupational therapy; medical social services; or personal care services.
(b) The Mayor shall have the authority to define variant types of facilities and agencies reasonably classified within the broader categories defined in subsection (a) of this section, and may issue rules under § 44-504 with respect to these subtypes. The Mayor shall make the final determination of whether a particular facility or agency falls within a category defined in subsection (a) of this section or a subtype defined by the Mayor pursuant to this subsection.
(c) When used throughout this subchapter, the terms “facility” and “agency” and their plural forms shall, unless contextually inappropriate or subject to specific exception, apply to all of the facilities and agencies defined in subsection (a) of this section as well as those subtypes defined by the Mayor. The Mayor shall make the final determination of whether a provision is contextually inappropriate for a particular agency or facility.
§ 44–502. License requirements.
(a) Except as provided in subsections (b), (c), and (d) of this section, it shall be unlawful to operate a facility or agency in the District of Columbia, whether public or private, for profit or not for profit, without being licensed by the Mayor.
(b) This subchapter shall not apply to a facility or agency operated by the federal government or, except in the case of community residence facilities, by and for the adherents of a church or religious denomination that, in accordance with established tenets, recognizes spiritual healing as the sole means of treating illness.
(c) Facilities and agencies that, prior to February 24, 1984, were not or would not have been subject to licensure in the District of Columbia may operate without a license until 6 months after the adoption of applicable rules under § 44-504.
(d) The continued operation of a facility or agency pending action by the Mayor on an application for licensure renewal or initial licensure under subsection (c) of this section shall not be deemed unlawful if a completed application was timely filed but, through no fault of the facility or agency or its governing body, staff, or employees, the Mayor has failed to act on the application before the expiration of the facility’s or agency’s current license or, under subsection (c) of this section, its authorized period of operation. A facility or agency operating under this subsection shall comply with all other provisions of this subchapter and rules adopted pursuant to this subchapter.
(e) Application forms shall list all certificates of approval, authority, occupancy, or need that are required as a precondition to lawful operation in the District of Columbia.
(f) A license shall be valid only for the premises stated on the license.
(g) Any change in the ownership of a facility or agency owned by an individual, partnership, or association, or in the legal or beneficial ownership of 10% or more of the stock of a corporation that owns or operates a facility or agency, shall be subject to written notice of the change being given to the governmental licensing authority at least 30 days prior to the change in ownership. Upon notification, the governmental licensing authority may, at its discretion, require reinspection and relicensure to ensure that the facility or agency will remain in compliance with the provisions of this subchapter, rules adopted pursuant to this subchapter, and all other applicable provisions of law.
(h) Unless sooner terminated or renewed, a license required by this subchapter shall expire one year from the date of issue or the last renewal.
(i) Each facility licensed under this subchapter shall post its license in a conspicuous place on the premises, and each agency licensed under this subchapter shall have its license readily available for inspection by the public.
(j) Any license issued pursuant to this section shall be issued as a Public Health: Health Care Facility endorsement or a Public Health: Human Services Facility endorsement to a basic business license under the basic business license system as set forth in subchapter I-A of Chapter 28 of Title 47.
§ 44–503. Authority of Mayor.
(a) The Mayor shall:
(1) Ensure that licensing rules are consistent with certificate of need rules and that both are designed to facilitate the goals and objectives of the District of Columbia’s state health plan and certificate of need program; and
(2) Conduct an initial inventory of facilities to determine actual physical bed capacity and operating bed capacity.
(b) The Mayor shall have the authority to license bed capacity by specific, well-defined services. For hospitals, licensure by type of service shall be limited to the following categories: Medical/surgical; ICU/coronary care; OB/GYN; nursery; intermediate neonatal and neonatal intensive care; pediatrics; alcoholism/chemical dependency; rehabilitation; and psychiatric.
§ 44–504. Rules.
(a) The Mayor shall issue rules, consistent with other provisions of this chapter and pursuant to subchapter I of Chapter 5 of Title 2, establishing:
(1) License fees for private facilities and agencies reasonably calculated to reflect a facility’s or agency’s respective share of the cost of administering the provisions of this subchapter and rules adopted pursuant to this subchapter;
(2) Procedures deemed necessary to effectuate the purposes of this subchapter, including, but not limited to, procedures for:
(A) Issuing and renewing licenses;
(B) Obtaining variances;
(C) Ensuring that 6 months after the adoption of applicable rules under this subsection, licensure of all affected facilities and agencies shall be under the new rules;
(D) Waiving the inspection requirements of § 44-505(a) and (b) for those agencies that deliver services within the District of Columbia but are headquartered and licensed outside the District of Columbia, when, in the opinion of the Mayor, licensure by another jurisdiction constitutes sufficient evidence that the agency is in substantial compliance with District of Columbia law;
(E) Processing and following up on complaints by facility and agency staff, consumers, and advocates that are filed with the governmental licensing authority;
(F) Suspending or revoking the license of a facility or agency that is in violation of any provision of this subchapter, rule adopted pursuant to this subchapter, or other provision of District of Columbia or federal law, or whose governing body, chief executive officer, administrator, or director has made a material misrepresentation of fact to a government official with respect to the facility’s or agency’s compliance with any provision of this subchapter, rule adopted pursuant to this chapter, or other provision of District of Columbia or federal law; and
(G) Appealing from adverse licensure decisions;
(3) Standards for the construction and operation of each type of facility and agency, including standards governing: safety and sanitation of facilities; organizational governance and administration; employee and volunteer training, staff membership and delineation of clinical privileges (in addition to the standards set forth in § 44-507), and other personnel matters; diagnostic, therapeutic, emergency, anesthesia, laboratory, pharmaceutical, dietary, nursing, rehabilitation, social, emergency and non-emergency transportation, and other services; infection control; patient/client/resident care and quality assurance; recordkeeping; utilization review; and internal complaint and appeal procedures; and
(4) A statement of patients’, clients’, and residents’ rights and responsibilities for each type of facility and agency, including the right to non-discrimination in treatment or access to services based on reasons prohibited by Unit A of Chapter 14 of Title 2.
(b) Repealed.
(c) In formulating the standards and statements of rights and responsibilities required by subsection (a)(3) and (4) of this section, the Mayor shall, within 30 days after February 24, 1984, appoint an advisory task force for each type of facility and agency except ambulatory surgical facilities and renal dialysis facilities. Each task force shall be composed of consumers, providers, advocates, and government agency representatives, and shall be charged with the responsibility of making formal written recommendations within a time frame established by the Mayor. The Mayor shall give substantial consideration to each task force’s recommendations and shall, on a continuing basis before adoption of proposed rules, maintain a dialogue with each task force while reviewing and acting on its recommendations.
(d) Where appropriate, standards adopted under subsection (a)(3) of this section may incorporate, in whole or in part, the standards of private accrediting bodies and standard-setting organizations, as well as the federal conditions of participation and standards for health-insurance and medical-assistance programs. Whenever the standards of a private accrediting body or standard-setting organization are revised and a copy is submitted to the Mayor, the Mayor shall evaluate the revised standards and determine whether any or all of them should be incorporated into new rules.
(e) Community residence facilities shall distribute a copy of the statement required by subsection (a)(4) of this section to each resident’s parents, guardian, or other responsible person acting on his or her behalf. All other facilities shall conspicuously post copies of this statement near the main entrance and on every floor. Agencies shall distribute a copy of this statement to each patient/client upon the initial delivery of services. Each copy shall specifically state, in boldface, the address and telephone number of the appropriate in-house or intra-agency personnel and governmental authority to which complaints should be addressed.
(e-1) For nursing facility residents, the statement required by subsection (a)(4) of this section shall include, at a minimum, the right to:
(1) Be fully informed by the nursing facility of all resident rights and all facility rules governing resident conduct and responsibilities upon admission and annually thereafter;
(2) Either manage one’s own personal finances, or be given a quarterly report of the resident’s finances if this responsibility has been delegated in writing to the nursing facility;
(3) Be treated with respect and dignity and assured privacy during treatment and when receiving personal care;
(4) Not be required to perform services for the nursing facility that are not for therapeutic purposes, as identified in the plan of care for the resident;
(5) Associate and communicate privately with persons of the resident’s choice, unless medically contraindicated;
(6) Send and receive personal mail, unopened by personnel at the nursing facility;
(7) Participate in activities of social, religious, and community groups at the discretion of the resident, unless medically contraindicated;
(8) Keep and use personal clothing and possessions, as space permits, unless to do so would infringe on other residents’ rights or is medically contraindicated;
(9) Maintain, at the nursing facility, a private locker, chest, or chest drawer that is large enough to accommodate jewelry and small personal property and that can be locked by the resident;
(10) Be provided with privacy for visits by the resident’s spouse or domestic partner, or, if spouses or domestic partners are both residents in the nursing facility, be permitted to share a room;
(11) Be free from mental or physical abuse;
(12) Be free from chemical and physical restraints except as authorized pursuant to federal or District law and regulation;
(13) Be transferred or discharged only for the grounds set forth in § 44-1003.01; and
(14) Be discharged from the nursing facility after:
(A) Receiving a consultation from a physician of the medical consequences of discharge; and
(B) Providing the administrator, physician, or a nurse of the nursing facility written notice of the desire to be discharged; provided, that if the resident is a minor or a guardian has been appointed for a resident, the written request for discharge shall be signed by the resident’s guardian, unless there is a court order to the contrary.
(f) In setting standards under subsection (a)(3) of this section, the Mayor shall require that hospice and home care agency programs be centrally administered and organized to ensure effective coordination of all patient/client care services.
(g) Nothing in this section shall be construed to prohibit a facility or agency from supplementing the standards adopted under subsection (a)(3) of this section by establishing internal standards, policies, and procedures that promote safety and quality care, so long as they are reasonable and not inconsistent with this subchapter, rules adopted pursuant to this subchapter, or other District of Columbia law.
(h) Repealed.
(h-1)(1) As part of the standards for nursing facilities required by subsection (a)(3) of this section, the Mayor shall require nursing facilities to:
(A) Maintain an organizational and staffing structure that promotes assignment of the same caregivers to care for the same residents as often as practicable;
(B) Except as provided in paragraph (2) of this subsection:
(i) Beginning January 1, 2011, have either a physician, physician assistant, or an advanced practice registered nurse, excluding the medical director, available on-site for a minimum of 0.2 hours per week for each resident at the facility; and
(ii) Beginning January 1, 2012, provide a minimum daily average of 4.1 hours of direct nursing care per resident per day, of which at least 0.6 hours shall be provided by an advanced practice registered nurse or registered nurse, which shall be in addition to any coverage required by sub-subparagraph (i) of this subparagraph;
(C) Provide annual training to all nursing home employees on the appropriate use of emergency transport and 911 services;
(D) Make each resident’s attending physician’s contact information readily available to facility staff as well as to each resident and his or her family or legal representative upon request;
(E) Provide employee training that addresses the special health care needs of the elderly and that addresses the needs of specific populations, including those characterized by:
(i) Race;
(ii) Ethnicity;
(iii) Religious affiliation;
(iv) Sexual orientation;
(v) Gender; and
(vi) Gender identity;
(F) Ensure that appropriate health care services are available on-site, as determined by the Department of Health, for the purpose of reducing the need to transport residents off-site for routine health services, including:
(i) Podiatry;
(ii) Rehabilitative services, such as physical therapy and occupational therapy;
(iii) Wound care;
(iv) Mental health;
(v) Dialysis; and
(vi) Substance-abuse treatment;
(G) Develop and maintain written policies and procedures governing the management and operation of the facility, which shall be required by the Department of Health as a component of licensure, reviewed by the Department of Health, and made available upon request, including policies and procedures governing:
(i) Nursing services;
(ii) Physician services;
(iii) Emergency care;
(iv) Dental services;
(v) Ventilator services;
(vi) Use of physical and chemical restraints;
(vii) Infection control;
(viii) Medication management;
(ix) Podiatry services;
(x) Dialysis services;
(xi) Recreational services;
(xii) Emergency water supply;
(xiii) Laundry and linen management;
(xiv) Fire and disaster preparedness; and
(xv) Resident emergency and non-emergency transportation.
(H) Based on a resident’s right to participate in resident and family groups (Requirements For Long Term Care Facilities, 42 C.F.R. § 483.15(c)), make available to any resident or family group:
(i) Promotional and advertising assistance so that residents and residents’ family members are aware of their right to convene groups;
(ii) Adequate meeting space and logistical assistance;
(iii) Information regarding policies and procedures for nursing home care, resident rights and responsibilities, and laws and rules that apply to the facility and its residents;
(iv) Staff for the operation of each meeting, upon request; and
(v) Written feedback and responses to recommendations and grievances;
(I) Ensure that a resident is seen by a physician within 72 hours of admission and has recorded in his or her medical record:
(i) An evaluation of the resident’s primary diagnoses;
(ii) The resident’s:
(I) Height;
(II) Weight;
(III) Mental health status; and
(IV) Personal care needs;
(iii) Whether it is medically contraindicated for the resident to participate in:
(I) Physical;
(II) Recreational; or
(III) Rehabilitative activities; and
(iv) An evaluation of any existing:
(I) Medical care plan;
(II) Treatment orders; and
(III) Medications;
(J) Obtain a medical order from the resident’s attending physician, the facility’s medical director, an on-staff physician, or advanced practice registered nurse if a resident requires medical treatment prior to calling 911; provided, that a prior medical order shall not be required if it is determined that there is a situation that requires an immediate transfer to a hospital; provided further, that if a nursing facility does not obtain a required medical order prior to calling 911, the facility shall document in the resident’s medical record why obtaining a medical order was not practicable; and
(K) Conduct a discharge assessment within 14 days of admission, and biannually thereafter, that includes:
(i) A time frame for discharging the resident to return home or to another facility; and
(ii) If the resident is likely to be discharged within 6 months of the discharge assessment, a discharge plan.
(2) The Department of Health shall have the authority to adjust the staffing requirements and formulas set forth in paragraph (1)(B)(i) and (ii) of this subsection based on the individual needs of a nursing facility; provided, that the staffing requirements set forth in paragraph (1)(B)(ii) of this subsection shall never be less than 3.5 hours of direct nursing care per resident per day.
(i)(1) As part of the standards for hospitals and renal dialysis facilities required by subsection (a)(3) of this section, the Mayor shall establish standards and procedures with respect to:
(A) The labeling, handling, transporting, storage, routine inspection, and preventive maintenance of dialysis equipment;
(B) The reprocessing and reuse of hemodialyzers, dialysate port caps, and blood port caps;
(C) Water purification and quality;
(D) The flushing of residues from potentially toxic sterilants and disinfectants used during manufacture or reprocessing;
(E) The facility’s responsibility to ensure individualized treatment, including the most appropriate choice of equipment for each patient and, for patients exhibiting hypersensitivity, the use of biocompatible membranes;
(F) The reporting of equipment failures and occurrences of pyrexia, sepsis, or bacteremia;
(G) The training, minimum qualifications, and supervision of dialysis staff; and
(H) The training and support provided to self-dialysis and home dialysis patients.
(2) The standards and procedures required by paragraph (1) of this subsection shall not be less stringent than the guidelines set forth in the July 28, 1986, Recommended Practice for Reuse of Hemodialyzers published by the Association for the Advancement of Medical Instrumentation (“AAMI Recommended Practice”) and the recommendations of the Centers for Disease Control referenced in those guidelines (“CDC Recommendations”).
(3) Until the standards and procedures required by paragraph (1) of this subsection become enforceable through licensure, hospitals and renal dialysis facilities shall comply with the AAMI Recommended Practice, except that, where there are CDC Recommendations, hospitals and renal dialysis facilities shall comply with the CDC Recommendations.
(4) No hospital or renal dialysis facility shall reuse blood tubing or transducer protectors.
(5) No hospital or renal dialysis facility shall reuse a hemodialyzer or dialyzer caps on a patient unless that patient has first signed a written consent form after having been orally advised by a physician of the potential risks, benefits, and uncertainties surrounding reuse and the disinfection process. The advising physician shall not be a medical director of the facility or dialysis unit, nor shall he or she have a financial interest in the facility. The information conveyed shall consist of a full and fair presentation of representative opinions from those in the medical community who have expressed concerns about reuse practices, and those who support these practices. Any discussion of “first-use syndrome” shall include information about advances in biocompatible-membrane technology.
(6) Dialysis patients shall have the following nonwaivable rights, to be supplemented by the statement of rights and responsibilities established by the Mayor pursuant to subsection (a)(4) of this section:
(A) To revoke or limit, either orally or in writing, a previously executed reuse consent at any time and for any reason;
(B) To be informed before each dialysis treatment of the number of times the dialyzer and dialyzer caps have been previously used;
(C) To have documented in their patient-care records all consents to reuse, refusals to consent, revocations of consent, and limitations placed upon consent;
(D) To have unrestricted access to their patient-care records;
(E) To make the reuse-content decision in an environment devoid of threats, intimidation, or retaliation by the facility or its staff; and
(F) Except as provided by paragraph (7) of this subsection, to remain at a facility and receive treatments with a new, state-of-the-art dialyzer and new dialyzer caps whenever consent to reuse is refused or revoked or reuse is prohibited by limitations placed upon consent.
(7) A hospital or renal dialysis facility may transfer or decline to admit a patient on account of that patient’s refusal to consent to the reuse of hemodialyzers or dialyzer caps only if:
(A) The Mayor certifies that the facility is currently in full compliance with this subsection and all other District of Columbia laws that regulate, either directly or indirectly, the reprocessing and reuse of hemodialyzers and dialyzer caps;
(B) The facility, in cooperation with a patient-care ombudsman designated by the Mayor, identifies and secures a permanent placement for the patient in an alternative facility within the District of Columbia where that patient will be provided the option of receiving each treatment with a new, state-of-the-art dialyzer and new dialyzer caps; and
(C) The patient-care ombudsman designated by the Mayor finds that the patient can obtain equally reliable transportation to and from the alternative facility without suffering extreme physical, psychological, or financial hardship.
(8) Paragraphs (3) through (7) of this subsection shall be applicable and enforceable with respect to all hospitals and renal dialysis facilities, whether licensed or temporarily exempt from licensure under § 44-502(c), immediately on February 28, 1987.
(j) The proposed rules, except those rules that establish or modify license fees as described in subsection (a) of this section, shall be submitted to the Council for a 45-day period of review, excluding Saturdays, Sundays, legal holidays, and days of Council recess. If the Council does not approve or disapprove the proposed rules, in whole or in part, by resolution within this 45-day review period, the proposed rules shall be deemed approved. Nothing in this section shall affect any requirements imposed upon the Mayor by subchapter I of Chapter 5 of Title 2.
(k) Any license issued pursuant to this section shall be issued as a Public Health: Health Care Facility endorsement or a Public Health: Human Services Facility endorsement to a basic business license under the basic business license system as set forth in subchapter I-A of Chapter 28 of Title 47.
§ 44–505. Inspections.
(a) To ensure that each new facility and agency will be in compliance with the provisions of this subchapter, rules adopted pursuant to this subchapter, and all other applicable laws and rules, the Mayor shall conduct an on-site inspection prior to a facility’s or agency’s initial licensure. Instead of issuing a full-year license to a new facility or agency, the Mayor may issue a provisional license under § 44-506 pending satisfactory completion of additional, follow-up inspections.
(b) After initial licensure the Mayor shall conduct an on-site inspection as a precondition to licensure renewal, except that the Mayor may accept accreditation by a private accrediting body, federal certification for participation in a health-insurance or medical assistance program, or federal qualification of a health maintenance organization as evidence of, and in lieu of inspecting for, compliance with any or all of the provisions of this subchapter and rules adopted pursuant to this subchapter that incorporate or are substantially similar to applicable standards or conditions of participation established by that body or the federal government. Acceptance of private accreditation by the Mayor shall be contingent on the facility’s or agency’s:
(1) Notifying the Mayor of all survey and resurvey dates no later than 5 days after it receives notice of these dates;
(2) Permitting authorized government officials to accompany the survey team; and
(3) Submitting to the Mayor a copy of the certificate of accreditation, all survey findings, recommendations, and reports, plans of correction, interim self-survey reports, notices of noncompliance, progress reports on correction of noncompliances, preliminary decisions to deny or limit accreditation, and all other similar documents relevant to the accreditation process, no later than 5 days after their receipt by the facility or agency or submission to the accrediting body.
(c) An authorized government official may enter the premises of a facility or agency during operating hours for the purpose of conducting an announced or unannounced inspection to check for compliance with any provision of this subchapter, rule adopted pursuant to this subchapter, or other provision of District of Columbia law. In conducting an inspection, the official shall make every effort not to disrupt the normal operations of the facility or agency and its staff.
(d)(1) If a facility or agency loses private accreditation or federal certification, it shall give the Mayor written notice of the loss within 5 calendar days. If in such a case accreditation or certification was accepted in lieu of an inspection under subsection (b) of this section, the Mayor shall immediately upon notification:
(A) Convert the facility’s or agency’s license to a provisional or restricted license under § 44-506 pending satisfactory completion of an inspection conducted by the Mayor; or
(B) Suspend the facility’s or agency’s license based upon a finding that loss of accreditation or certification was prompted by existing deficiencies that constitute an immediate or serious and continuing danger to the health, safety, or welfare of its patients/clients/residents.
(2) The Mayor may, prior to a hearing, suspend the license of any facility or agency or convert its license to a provisional or restricted license if he or she determines that existing deficiencies constitute an immediate or serious and continuing danger to the health, safety, or welfare of its patients/clients/residents.
(3) Upon the suspension or conversion of a license pursuant to this subsection, the Mayor shall immediately give the facility or agency written notice of the action, including a copy of the order of suspension or conversion, a statement of the grounds for the action, and notification that the facility or agency has 7 days (excluding Saturdays, Sundays, and legal holidays) from the day written notice is received to request an expedited, preliminary review hearing. If the facility or agency fails to communicate, either orally or in writing, a timely request for a preliminary review hearing, the order of suspension or conversion shall remain in effect until terminated by the Mayor or an unexpedited hearing is held pursuant to procedures adopted under § 44-504. Upon receipt of a timely request for an expedited, preliminary review hearing, the Mayor shall within 72 hours (excluding Saturdays, Sundays, and legal holidays) provide a hearing to review the reasonableness of the suspension or conversion order. At this hearing, the Mayor shall have the burden of establishing a prima facie case of immediate or serious and continuing endangerment. The suspension or conversion order shall be either affirmed or vacated at the hearing. In the event an order is affirmed, it shall, unless extended, remain in effect for no longer than 30 calendar days, during which time a final hearing shall be scheduled to consider the appropriateness of revocation or continuing restrictions on licensure. Before expiration of a suspension or conversion order, an extension may be granted for a period not to exceed an additional 30 calendar days upon agreement of all the parties or for good cause shown.
(e) The Mayor shall have the authority, upon a showing of undue hardship and if not inconsistent with other provisions of this chapter or deleterious to the public health and safety, to grant variances with respect to the standards to be established under § 44-504(a)(3) and (h-1). The Mayor shall maintain a public record listing all variances granted under this subsection and containing a complete written explanation of the basis for each variance.
§ 44–506. Provisional and restricted licenses.
(a) As an alternative to denial, nonrenewal, suspension, or revocation of a license when a facility or agency has numerous deficiencies or a serious single deficiency with respect to the standards to be established under § 44-504(a)(3), the Mayor may:
(1) Issue a provisional license if the facility or agency is taking appropriate ameliorative action in accordance with a mutually agreed upon timetable; or
(2) Issue a restricted license that prohibits the facility or agency from accepting new patients/clients/residents or delivering certain specified services that it would otherwise be authorized to deliver, if appropriate ameliorative action is not forthcoming.
(b) As provided in § 44-505(a), provisional licenses may be issued to new facilities and agencies in order to afford the Mayor sufficient time and evidence to evaluate whether a new facility or agency is capable of complying with the provisions of this subchapter, rules adopted pursuant to this subchapter, and other applicable provisions of law.
(c) Except as provided in subsection (f) of this section, provisional licenses may be granted for a period not exceeding 90 days, and may be renewed no more than once.
(d) Any provisional license issued pursuant to this section shall be issued as a provisional Public Health: Health Care Facility endorsement or a provisional Public Health: Human Services facility endorsement to a basic business license under the basic business license system as set forth in subchapter I-A of Chapter 28 of Title 47.
(e) If a facility is issued a restricted or provisional license, the Department of Health may, if appropriate, appoint a temporary manager or monitor in accordance with a mutually agreed upon timetable or until the facility becomes compliant with § 44-504(a)(3) and (h-1).
(f)(1) If a notice of closure of a health care facility or health service is denied by the State Health Planning and Developmental Agency pursuant to § 44-406(c), the Director of the Department of Health may issue a provisional license to the health care facility or health service to continue to operate for up to 3 years.
(2) For the purposes of this subsection, the terms "health care facility" and "health service" shall have the same meanings as provided in § 44-401(10) and (12)), respectively.
§ 44–507. Standards for clinical privileges and staff membership; anticompetitive practices prohibited.
(a) The accordance and delineation of clinical privileges shall be determined on an individual basis and commensurate with an applicant’s education, training, experience, and demonstrated current competence. In implementing these criteria, each facility and agency shall formulate and apply reasonable, nondiscriminatory standards for the evaluation of an applicant’s credentials. As part of its overall responsibility for the operation of a facility or agency, the governing body, or designated persons so functioning, shall ensure that decisions on clinical privileges and staff membership are based on an objective evaluation of an applicant’s credentials, free of anticompetitive intent or purpose. Whenever possible, the credentials committee and other staff who evaluate and determine the qualifications of applicants for clinical privileges and staff membership shall include members of the applicant’s profession. The credentials committee shall accept the District of Columbia’s uniform credentialing form as the sole application for a healthcare provider to become credentialed or recredentialed.
(b)(1) The following are not valid factors for consideration in the determination of qualifications for staff membership or clinical privileges:
(A) An applicant’s membership or lack of membership in a professional society or association;
(B) An applicant’s decision to advertise, lower fees, or engage in other competitive acts intended to solicit business;
(C) An applicant’s participation in prepaid group health plans, salaried employment, or any other manner of delivering health services on other than a fee-for-service basis;
(D) An applicant’s support for, training of, or participation in a private group practice with members of a particular class of health professional;
(E) An applicant’s practices with respect to testifying in malpractice suits, disciplinary actions, or any other type of proceeding; and
(F) An applicant’s willingness to send a certain amount of patients/clients who are in need of the services of a facility or agency to a particular facility or agency; provided, that this last restriction shall not apply to public facilities and agencies.
(2) Each facility or agency shall formulate procedures to ensure that the foregoing factors play no part when decisions regarding clinical privileges and staff membership are made. In any action brought by an individual against a facility or agency regarding a determination of clinical privileges or staff membership, the facility or agency shall have the burden of proving that none of these considerations were a factor in the determination.
(c) No provision of District of Columbia law, institutional or staff bylaw of a facility or agency, rule or regulation, or practice shall prohibit qualified advanced practice registered nurses, podiatrists, or psychologists from being accorded clinical privileges and appointed to all categories of staff membership at those facilities and agencies that offer the kinds of services that can be performed by either members of these health professions or physicians.
(d) General and family practitioners who have demonstrated a current competence in the performance of particular services or procedures shall not be discriminated against with respect to staff membership or the accordance and delineation of clinical privileges on account of their type of practice.
(e) If a facility or agency offers the types of services that can be performed by physician assistants or other, analogous health professional assistants, it shall establish clearly defined and objective procedures for the processing and evaluation of requests by members of these groups to provide such services at the facility or agency.
(f) Whenever a health professional submits a completed application for staff membership or clinical privileges to a facility or agency, that facility or agency shall have 120 calendar days to grant or deny the application. No facility or agency may deny such an application, terminate, or reduce the rights and responsibilities attending the staff membership of a health professional, or reduce, suspend, revoke, or refuse to renew his or her clinical privileges, without providing him or her with the following minimum procedural protections:
(1) A contemporaneous written explanation containing the explicit reasons for taking the action;
(2) Reasonable advance notice of the right to a fair hearing which would afford the applicant an opportunity to adequately prepare a rebuttal to the stated reasons for the action;
(3) A fair hearing, including the right to present evidence and call witnesses in his or her behalf;
(4) The right to have retained counsel present at the hearing if the facility or agency is represented by counsel at the hearing;
(5) A written decision containing the explicit reasons for taking the action and substantially based on the evidence produced at the hearing; and
(6) Access to a complete record documenting all preliminary and final decisions and proceedings related to the decisions.
§ 44–508. Reporting to licensing authority.
(a)(1) A health professional shall submit a report notifying the board, commission, or authority responsible for licensing, registering, or certifying the health professional within 10 business days after:
(A) The health professional obtains knowledge that a health care licensing authority of another state has taken disciplinary action against him or her; or
(B) The health professional:
(i) Has been named in a malpractice suit and received notice of a judgment against him or her in that suit;
(ii) Has been convicted of a crime; or
(iii)(I) Is party to a confidential settlement stemming from a malpractice claim to be paid by the health professional, an insurer, or other entity on behalf of the health professional.
(II) For a report arising from a confidential settlement pursuant to sub-sub-subparagraph (I) of this sub-subparagraph, the health professional shall not include in a report any details required by the settlement to be kept confidential.
(2) Consistent with paragraph (1) of this subsection, nothing in a confidential settlement agreement between a health professional, the insurer of the health professional, or other entities acting on behalf of the health professional and another person shall operate to prevent the parties to that agreement from filing a complaint with the board, commission, or authority responsible for licensing, registering or certifying the health professional, or from testifying in any investigation conducted by the board, commission, or authority responsible for licensing, registering, or certifying the health professional.
(a-1) A health professional's employer shall submit a report notifying the board, commission, or authority responsible for licensing, registering, or certifying a health professional within 10 business days after:
(1) The health professional's employer has:
(A) Reduced, suspended, revoked, or not renewed the health professional's clinical privileges;
(B) Involuntarily terminated or restricted the health professional's employment or staff membership; or
(C) Asked the health professional to resign because the health professional's conduct has been determined, pursuant to § 3-1205.14(c), to have committed a violation listed in § 3-1205.14(a); or
(2) The health professional has voluntarily resigned, or has been asked by the health professional employer to resign, while being investigated by the health professional employer for conduct in violation listed in § 3-1205.14(a).
(b) The reporting requirement in subsection (a-1) of this section shall not apply to a temporary suspension or relinquishment of privileges or responsibilities if a health professional enters and successfully completes a prescribed program of education or rehabilitation. As soon as there exists no reasonable expectation that he or she will enter and successfully complete such a prescribed program, the health professional's employer shall submit a report forthwith pursuant to subsection (a-1) of this section.
(c) The reports required by subsections (a) and (a-1) of this section shall be sent by registered or certified mail, with return receipt requested, or sent by a courier service, commercial carrier, or personal service, or to a secure email address created by the Department.
(d) In computing the 10 business-day reporting period in subsections (a) and (a-1) of this section, the day of the action or event that gave rise to the requirement to send the report shall not be counted. The last day of the 10-day period shall be counted unless it is a Saturday, Sunday, legal holiday, or day on which the Department of Health is officially closed, in which event the 10-day period shall continue until the next day that is not a Saturday, Sunday, legal holiday, or day on which the Department of Health is officially closed.
(e) The reporting required by subsections (a) and (a-1) of this section shall not act as a waiver of confidentiality of medical records and committee reports. Records reported and obtained under this section shall remain confidential and shall not be disclosed, except as otherwise authorized or required by law. The records shall be used by the board, commission, or authority responsible for licensing, registering or certifying the health professional in the exercise of their functions and shall be made available to the public only as required by subchapter II of Chapter 5 of Title 2.
(f) Any health professional employer, or employee of such employer, participating in good faith in the making of a report pursuant to this subchapter shall have immunity from liability, administrative, civil, and criminal, that might otherwise be incurred or imposed with respect to the making of the report. The same immunity shall extend to participation in any judicial proceeding involving the report. In all administrative, civil, or criminal proceedings concerning the employee resulting from the report, there shall be a rebuttable presumption that the maker of the report acted in good faith.
§ 44–509. Penalties; enforcement.
(a) Any person who intentionally impedes a District of Columbia official or employee in the performance of his or her authorized duties under this subchapter, or any rule issued pursuant to this subchapter, shall be subject to a fine not exceeding $1,000 per day of violation, imprisonment for not more than 90 days, or both. Prosecution shall be in the Superior Court of the District of Columbia by information signed by the Attorney General for the District of Columbia or one of his or her assistants.
(b) Notwithstanding the availability of any other remedy, the Attorney General for the District of Columbia or one of his or her assistants may maintain, in the name of the District of Columbia, an action in the Superior Court of the District of Columbia to enjoin any person, agency, corporation, or other entity from operating a facility or agency in violation of the terms of its license, provisions of this subchapter, or any rule issued pursuant to this subchapter.
(c) Notwithstanding the availability of any other remedy, an individual who is aggrieved by a violation of any provision of this subchapter or rule issued pursuant to this subchapter may maintain an action in the Superior Court of the District of Columbia to enjoin the continuation of that violation or the commission of any future violation.
(d)(1) Any person who knowingly gives an owner, licensee, administrator, or employee of a facility or agency, whether directly or indirectly, advance notice of an officially unannounced inspection or investigation to be conducted by the Mayor, the Long-Term Care Ombudsman designated pursuant to 42 U.S.C. § 3027(a)(12), or their designees, shall be:
(A) Guilty of a misdemeanor and, upon conviction, subject to a fine not exceeding $5,000, imprisonment for not more than 90 days, or both; and
(B) If a District government employee, subject to disciplinary and other remedial action in accordance with District law.
(2) Prosecution under paragraph (1)(A) of this subsection shall be in the Superior Court of the District of Columbia by information signed by the Attorney General for the District of Columbia or one of his or her assistants.
(e)(1) Civil fines, penalties, and related costs may be imposed against a facility or agency, whether public or private, for the violation of any provision of this subchapter, rule issued pursuant to this subchapter (including residents’ rights established pursuant to § 44-504(a)(4)), or other District of Columbia or locally enforceable federal law. Except as provided in paragraphs (2) through (5) of this subsection and subsection (f)(1) of this section, procedures for adjudication and enforcement and applicable fines, penalties, and costs shall be those established by or pursuant to Chapter 18 of Title 2. Governmental immunity shall not be a defense to any civil fine, penalty, or cost imposed.
(1A)(A) For health professional or health professional's employer that fails to comply with the reporting requirements set forth in § 44-508, the Mayor may impose a civil fine not to exceed $2,500 for the first incident, $5,000 for the second incident, and $10,000 for any violations occurring thereafter.
(B) In a proceeding to determine whether a health professional or health professional's employer has complied with the requirements of § 44-508, or in a proceeding challenging the imposition of a fine for failure to comply with the requirements of § 44-508, the health professional or health professional's employer shall have the burden of proving that the report was sent to the board, commission, or authority through one of the methods of service identified in § 44-508(c) if the board, commission, or authority states that it has not received the report.
(2) Whenever the respondent in proceedings for a civil fine or penalty is the licensee or administrator of a nursing home or community residence facility, the Long-Term Care Ombudsman shall have the right to intervene as a party in any hearing, administrative appeal, or court review that is a part of those proceedings. As a party to the proceedings, the Long-Term Care Ombudsman shall be served with a copy of the notice of infraction, all hearing notices, all orders of the Administrative Law Judge, any notices of appeal, and any orders of a court.
(3) Civil fines, penalties, and related costs imposed against a nursing home or community residence facility shall not come out of the funds needed to provide quality care and services to residents. To monitor compliance with this paragraph, the Mayor shall conduct an audit at least annually of every nursing home and community residence facility against which civil fines, penalties, or costs have been imposed. Civil fines, penalties, and costs imposed against any nursing home or community residence facility owned by the District of Columbia shall be paid into either the special fund or account if established pursuant to § 44-1002.09, or a special account to be used for the personal needs of residents.
(4) Notwithstanding the availability of other means of enforcement, the Mayor may directly deduct the amount of civil fines, penalties, and related costs imposed against any facility or agency from amounts otherwise payable by the District of Columbia to the licensee or administrator of that facility or agency.
(5) Any person who violates any provision of this subchapter, or any rules or regulations promulgated pursuant to this subchapter, for which a civil fine has not been established pursuant to § 2-1801.04, shall be subject to a civil fine in an amount not to exceed that established for the closest existing analogous violation.
(f)(1) Any person who commits a violation of any provision of this subchapter, or any rules or regulations promulgated pursuant to this subchapter, that results in demonstrable harm to a patient, resident, or client of a facility or agency, shall be subject to a fine for each offense not to exceed $10,000. For each violation, each day of violation shall constitute a separate offense, and the penalties prescribed shall apply to each separate offense. The total fine for a series of related offenses shall not exceed $100,000. Procedures for adjudication of violations under this subsection shall be those established pursuant to Chapter 18 of Title 2.
(2) Except as provided in subsections (a) and (d) of this section, any person who knowingly violates this subchapter, or any rules or regulations promulgated pursuant to this subchapter, shall be guilty of a misdemeanor, and, upon conviction, shall be fined not more than $25,000, or imprisoned for not more than 180 days, or both. For each violation, each day of violation shall constitute a separate offense, and the penalties prescribed shall apply to each separate offense. Prosecutions for violation of this subchapter pursuant to this subsection shall be brought in the Superior Court of the District of Columbia by the Attorney General for the District of Columbia.
Subchapter I-A. Ambulatory Surgical Treatment Center Licensure.
Part A. Purpose and Scope; Definitions.
§ 44–531.01. Purpose and scope.
The purpose of this subchapter is to require licensure of all facilities, except as provided in § 44-531.02, in which surgical procedures are performed on persons who are not admitted as inpatients to a hospital, and to provide minimum standards for the establishment and maintenance of such facilities.
§ 44–531.02. Definitions.
For the purposes of this subchapter:
(1)(A) "Ambulatory Surgical Treatment Center" means any institution, place or building devoted primarily to the maintenance and operation of facilities for the performance of surgical procedures on an outpatient basis including facilities where family planning procedures are performed. Such facility shall not provide beds or other accommodations for the overnight stay of patients. Individual patients shall be discharged in an ambulatory condition without danger to the continued well being of the patients or shall be transferred to a hospital.
(B) The term "Ambulatory Surgical Treatment Center" does not include:
(i) Any institution or building licensed as a hospital, under subchapter I of Chapter 7 of this title;
(ii) Hospitals maintained by the District of Columbia;
(iii) Any place, agency, clinic or practice, public or private, profit or nonprofit, devoted exclusively to the performance of dental or oral surgical procedures;
(iv) Any professional office wherein a physician customarily performs surgical procedures for minor diagnosis and treatment of dermatological or podiatric condition or cystoscopies or proctoscopies.
(2) "Center" means an Ambulatory Surgical Treatment Center.
(3) "Department means the Department of Human Resources of the District of Columbia.
(4) "Director" means the Director of the Department of Human Resources, or his designee.
(5) "District" means the District of Columbia.
(6) "Mayor" means the holder of the Office of the Mayor of the District of Columbia, pursuant to § 1-204.21, or his designated agent.
Part B. Licensure of Ambulatory Surgical Treatment Centers.
§ 44–532.01. License required.
No person shall operate an Ambulatory Surgical Treatment Center without having in effect a license issued by the Mayor in accordance with this subchapter. Such license shall be renewed annually and posted conspicuously within the premises of the facility. The annual fee for the license shall be $100.
§ 44–532.02. Application.
Application for license to operate a center shall be made to the Mayor on forms furnished by him and shall include, but not be limited to, the following information:
(1) The name and address of the facility;
(2) The names and addresses of the owners of the facility. If the owner is a corporation, the application shall include the names and addresses of all officers of the corporation and all persons having a 10% or more ownership interest;
(3) The medical and surgical procedures for which the center is to be licensed;
(4) The names and addresses of the center's administrator and medical director;
(5) Evidence of capacity to provide emergency care or secure appropriate emergency care expeditiously for a patient. Such evidence shall include, at a minimum:
(A) Provision of appropriately trained staff, space, equipment and supplies to stabilize the condition of a patient prior to transport to a hospital; and
(B) Agreement(s) between the center and a hospital not more than 20 minutes ambulance driving time from the center that the hospital will admit all center patients needing emergency care, or proof that all physicians using the center have, or a center staff physician is always available who has, admitting privileges at a hospital not more than 20 minutes ambulance time from the center.
§ 44–532.03. Financial responsibility.
Each applicant for a surgical center license shall, as a condition to the issuance of such license, submit evidence satisfactory to the Mayor of liability insurance coverage of no less than $100,000 per occurrence and $300,000 in the aggregate.
§ 44–532.04. Refusal to Issue or Renew License; Revocation or Suspension.
The Mayor may refuse to issue, or to renew, or may revoke or suspend, the license of a center for any of the following reasons:
(1) Violation of any provision of this subchapter;
(2) Knowingly furnishing false or misleading information to the Mayor, or failure to furnish information requested;
(3) Knowingly furnishing false, misleading or fraudulent information regarding the center to the public;
(4) Imminent danger to public health or welfare;
(5) Failure to maintain acceptable standards of cleanliness and sanitation required of surgical units.
§ 44–532.05. Notice and hearings.
When the Mayor determines that there are grounds for denial, suspension or revocation of a license under this subchapter, the Mayor shall serve upon the applicant or licensee a written notice of the proposed action, informing the applicant or licensee of his right to request, within 7 days from service of notice, a hearing before the Mayor at which time the applicant or licensee may show cause why his application for a license or renewal of his license should not be denied or his license not suspended or revoked. The notice to the applicant or licensee shall also specify what action, whether it be denial, suspension or revocation, is contemplated, the grounds therefor, and that such proposed action shall be taken in no hearing is requested.
Part C. Center Administration and Management.
§ 44–533.01. Organization of center.
(a) Each surgical center shall have a governing board formally organized in accordance with written by-laws. Such by-laws shall establish procedures for the appointment of the center administrator and medical director, for the admission of physicians to practice at the center, for revocation or suspension of a physician's center privileges, and for patient admissions and discharge. A copy of the by-laws shall be available for public inspection at all times.
(b) A center owned by a sole proprietorship, partnership or professional medical corporation shall not be required to have a governing board, but the center shall have written procedures, available for public inspection at all times, governing the admission for physicians to practice at the center, for revocation or suspension of a physician's center privileges, and for patient admissions and discharge.
§ 44–533.02. Center operation.
Responsibility for operation of the center shall rest with the center administrator, except that direct patient care shall be the responsibility of the medical director. The administrator may not also serve as medical director.
§ 44–533.03. Staffing.
Each center shall have an administrator and a medical director. The director must be a physician licensed to practice the healing art in the District of Columbia. There shall be sufficient professional staff to perform services for which the center is licensed in conformity with generally accepted standards of good medical practice. No clinical procedure may be performed unless sufficient professional staff is on duty to both carry out the procedure and render any emergency services that may be needed, including, if necessary, accompanying the patient to a hospital.
§ 44–533.04. Pre-operative requirements.
(a) A current statement in writing indicating informed consent and a signed authorization by the patient for the performance of a surgical procedure shall be procured and shall form a part of the patient's medical record.
(b) Appropriate medical history shall be obtained and the physical examination shall be sufficient to determine the state of health of the patient prior to performance of the surgical procedure.
(c) Appropriate current laboratory tests shall be performed on patients in accordance with standard medical practice.
(d) Written policies and procedures for coordination or referral from various sources, including transmittal of appropriate patient records, shall be established by the Medical Director and adhered to by all members of the staff.
§ 44–533.05. Post-operative requirements.
(a) Each center shall establish a program to ensure post surgical treatment for each individual treated in the center and shall include (but is not limited to) the following written instructions to be issued to all patients:
(1) Symptoms of complications to be looked for;
(2) Activities to be avoided, if any;
(3) Specific telephone number to be used by the patient should any complication occur or question arise;
(4) Reminder to make arrangements with the center or the patient's personal physician for a post-operative check-up.
(b) Following the surgical procedure, patients shall be observed in the center for a period of time sufficient to ensure that no immediate post-operative complications are present following the administration of anesthetics.
(c) Patients in whom any adverse condition exists or in whom complication is known or suspected to have occurred during or after the performance of the surgical procedure shall be transferred and admitted to a hospital, if good medical practice so indicates.
§ 44–533.06. Center records and report requirements.
(a) Accurate and complete clinical records shall be maintained for each patient and all entries in the clinical record shall be made at the time the surgical procedure is performed and when care, treatment, medications or other medical services are given. The record shall satisfy the diagnosis or need for medical services. It shall include where applicable but not be limited to the following:
(1) Patient identification;
(2) Admitting information including patient history and physical examination;
(3) Signed informed consent;
(4) Signed and dated physician orders;
(5) Laboratory tests, pathologist's report of tissue, and radiologist report of x-rays, as indicated by good medical practice;
(6) Anesthesia record, if general anesthesia is used;
(7) Operative record as indicated by good medical practice;
(8) Surgical medication and medical treatments;
(9) Recovery room notes;
(10) Physician and nurses' progress notes;
(11) Condition at time of discharge; and
(12) Patient instructions.
(b) Accounting procedures shall be carried out in accordance with an accepted accounting system providing appropriate statistical information and shall permit satisfactory auditing.
(c) Each facility shall submit reports on a regular basis containing such pertinent clinical and statistical data as may reasonably be required by the Department, including mortality and morbidity data.
(d) All patient records shall be confidential, unless the patient gives written consent for their release, except as provided in § 44-535.01.
(e) All hospitals licensed under the laws of the District of Columbia, including D.C. General Hospital, shall regularly report to the Department any incidence of morbidity in cases treated at a center.
Part D. Center Equipment and Maintenance.
§ 44–534.01. Supplies and equipment for care.
There shall be sufficient equipment for patient care according to types of patients, service programs, and procedures. There shall be adequate monitoring equipment, oxygen and related items available within the surgical and post-operative recovery area. Cardiac-pulmonary resuscitation equipment with trained personnel shall be available in facilities utilizing general anesthesia. There shall be written procedures governing the care, use, sterilization, storage and disposal of all materials. There shall be written procedures to assure safety in storage and use of inhalation anesthetics, medical gases, narcotics and medications. A program shall be formulated and implemented which shall acquaint all personnel with the established medication policies and procedures and assure enforcement.
§ 44–534.02. Environmental health standards.
(a) Persons responsible for maintenance of the physical plant, including housekeeping, shall be specifically identified.
(b) Treatment rooms shall have a minimum clear floor area sufficient to permit removal of a patient by stretcher. A lavatory or sink with handwashing facility with controls appropriate for mode sterility technique used by the facility shall be provided.
(c) Illumination shall provide at least the equivalent of 100 foot candles of light at the examining table, as well as in the surgical area.
(d) There shall be a preventive maintenance program for mechanical equipment and medical devices. This program of prevention maintenance should include, but is not limited to, regularly scheduled inspection of medical equipment.
(e) There shall be convenient handwashing facilities and/or necessary control valves to minimize the potential of cross contamination.
(f) An environmental monitoring program, which shall include environmental surveillance and infection surveillance, shall be established and followed routinely.
Part E. Micellaneous Povisions.
§ 44–535.01. Inspection.
The Mayor shall have the right to inspect any facility licensed under this subchapter, any facility applying for a license under this subchapter, and all records maintained therein, at any reasonable time either with or without prior notice. The entry and inspection shall take place with the least possible disruption to the patients. Any information concerning the content of a facility's records shall not be released by the District of Columbia government until all patient names have been deleted.
§ 44–535.02. Prohibitions.
(a) No surgical procedure requiring general anesthesia shall be performed in a center except under the immediate medical direction of a physician licensed to practice the healing art in the District of Columbia and who is a qualified anesthesiologist.
(b) If a center knows, or reasonably should know, that any patient was referred to it by a referral services which charged a fee for such referral, the facility shall immediately report all pertinent facts of such alleged referral to the Corporation Counsel of the District of Columbia.
(c) "Fee-splitting", or the sharing of a fee between any physician, person, agency, or clinic, for any charge, services or referral by or with an ambulatory treatment center shall be prohibited.
§ 44–535.03. Penalty.
Any person violating any provision of these regulations shall be fined not more than $300, or imprisoned for not more than 90 days.
§ 44–535.04. Severability.
Any paragraph or subparagraph or any elements thereof of any section and each section and each paragraph and/or subparagraph of each section are hereby deemed as separate and independent.
Subchapter II. Unlicensed Personnel Criminal Background Check.
§ 44–551. Definitions.
For purposes of this subchapter, the term:
(1A) “Contract worker” means a compensated contractor for whom it is foreseeable he or she will come in direct contact with patients.
(1B) “Criminal background check” means an investigation into a person’s criminal history to determine whether, within the 7 years preceding the background check, the person has been convicted in the District of Columbia, or in any other state or territory of the United States where such person has worked or resided, of any of the offenses enumerated in § 44-552(e) or their equivalent in another state or territory.
(1C) “Facility” means any entity required to be licensed pursuant to subchapter I of this chapter or Chapter 1 of this title and any entity furnishing Medicaid services under a provider agreement with the District of Columbia in accordance with regulations promulgated under title XIX of the Social Security Act, approved July 30, 1965 (Pub. L. 89-97; 42 U.S.C. § 1396 et seq.).
(2) Repealed.
(3) “Medicaid services” means nursing facility services, home health-care services, inpatient hospital services and nursing facilities for individuals 65 years of age or older in an institution for mental disease, mental health rehabilitation services in an intermediate care facility for persons with intellectual disabilities home and community care for elderly individuals with functional disabilities, and community supported living arrangement services as defined in title XIX of the Social Security Act, approved July 30, 1965 (Pub. L. 89-97; 42 U.S.C. § 1396 et seq.).
(4) “Nurse Aide Abuse Registry” means a record, maintained by the District of Columbia in accordance with section 4211 of the Omnibus Budget Reconciliation Act of 1987, approved December 22, 1987 (101 Stat. 1330-182; 42 U.S.C. § 1396r), and 29 DCMR § 3250-3254, containing names of individuals who worked as nurse aides and were determined to have abused or neglected, or misappropriated the property of, a nursing home resident.
(5) “Person” means an individual.
(6) “Private agency” means an entity or person that offers customer assistance in the use of criminal background checks for employment purposes.
(7) “Unlicensed person” means a person not licensed pursuant to Chapter 12 of Title 3, who functions in a complementary or assistance role to licensed health care professionals in providing direct patient care or in performing common nursing tasks. The term “unlicensed person” includes nurse aides, orderlies, assistant technicians, attendants, home health aides, personal care aides, medication aides, geriatric aides, or other health aides. The term “unlicensed person” also includes housekeeping, maintenance, and administrative staff for whom it is foreseeable that the prospective employee or contract worker will come in direct contact with patients.
§ 44–552. Criminal background checks.
(a) The requirements of this section shall not apply to persons employed on or before July 23, 2001, persons licensed under Chapter 12 of Title 3, or to a person who volunteers services to a facility and works under the direct supervision of a person licensed pursuant to Chapter 12 of Title 3.
(b) No facility shall employ or contract with any unlicensed person until a criminal background check has been conducted for that person. Each facility shall inform each prospective employee or contract worker that the facility is required to conduct a criminal background check before employing or contracting with an unlicensed person.
(c) All criminal records received by a facility for the purposes of employing a person who is not a licensed professional pursuant to this subchapter shall be kept confidential and shall be used solely by the facility. The criminal records shall not be released or otherwise disclosed to any person except to:
(1) The Mayor or the Mayor’s designee during an official inspection or investigation of the facility;
(2) The person whose background is being investigated;
(3) Comply with an order of a court; or
(4) Any person with the written consent of the person being investigated.
(d) All criminal records received by a facility shall be destroyed after one year from the end of employment of the person to whom the records relate.
(e) No facility shall employ or contract with any unlicensed person if, within the 7 years preceding a criminal background check conducted pursuant to this section, that person has been convicted in the District of Columbia, or in any other state or territory of the United States where such person has worked or resided, of any of the following offenses or their equivalent in another state or territory:
(1) Murder, attempted murder, or manslaughter;
(2) Arson;
(3) Assault, battery, assault and battery, assault with a dangerous weapon, mayhem or threats to do bodily harm;
(4) Burglary;
(5) Robbery;
(6) Kidnapping;
(7) Theft, fraud, forgery, extortion or blackmail;
(8) Illegal use or possession of a firearm;
(9) Repealed.
(10) Rape, sexual assault, sexual battery, or sexual abuse;
(11) Child abuse or cruelty to children; or
(12) Unlawful distribution or possession with intent to distribute, a controlled substance.
(f) Repealed.
(g) No facility shall employ or contract with any unlicensed person who is not a licensed professional if that person’s name appears on the Nurse Aide Abuse Registry maintained pursuant to regulations promulgated by the Mayor.
(h) Each facility may obtain a criminal background check from the Metropolitan Police Department, the U.S. Department of Justice, or from a private agency. The facility shall pay the fee that is established and charged by the entity that provides the criminal background check results. Nothing in this subsection shall preclude the facility from seeking reimbursement of the fee paid for the criminal background check from the applicant for employment or contract work.
(i) Except as provided in subsection (a) of this section, a facility may also opt to conduct a criminal background check on any employee or volunteer who provides services at the facility.
§ 44–553. Penalties for unauthorized released of criminal information.
(a) Any person releasing or disclosing any information in violation of § 44-552(c) shall be guilty of a misdemeanor, and shall be punishable by the payment of a fine not greater than $300, a term of imprisonment not greater than 30 days, or both.
(b) Civil fines, penalties, and fees may be imposed as sanctions for any violation of this subchapter or the rules issued pursuant to this subchapter, pursuant to Chapter 18 of Title 2.
(c) No facility shall be subject to civil liability that in good faith relies on a criminal background check to terminate, or to refuse to offer employment to, any individual.
§ 44–554. Rules.
The Mayor may issue rules to implement this subchapter, including procedures for additional enforcement actions for violation of this subchapter and the setting of fees in accordance with the provisions of subchapter I of Chapter 5 of Title 2.
