§ 29.33. Requirements for abortion.

 Every medical facility shall meet the following requirements with respect to the provision of abortions:

   (1)  Each medical facility shall have readily available equipment and drugs necessary for resuscitation. If local anesthesia is utilized to perform an abortion in a medical facility during the first trimester, then the following equipment shall be ready to use for resuscitative purposes:

     (i)   Suction source.

     (ii)   Oxygen source.

     (iii)   Assorted size oral airways and endotracheal tubes.

     (iv)   Laryngoscope.

     (v)   Bag and mask and bag and endotracheal tube attachments for assisted ventilation.

     (vi)   Intravenous fluids including blood volume expanders.

     (vii)   Intravenous catheters and cut-down instrument tray.

     (viii)   Emergency drugs for shock and metabolic imbalance.

     (ix)   An individual to monitor respiratory rate, blood pressure and heart rate.

   (2)  In those situations where general anesthesia is utilized during the performance of an abortion, equipment ready to use for resuscitation shall be available as listed for local anesthesia and shall include, in addition, monitor defibrillator with electrocardiogram visual display of heart rate and rhythm.

   (3)  Abortions shall be performed only by a physician who possesses the requisite professional skill and competence as determined and approved by the medical facility in accordance with appropriate procedures.

   (4)  Each medical facility shall arrange for at least one physician who is board eligible by the American Board of Obstetrics and Gynecology or the American Osteopathic Board of Obstetrics and Gynecology to be available either as a staff member or as a consultant for the purpose of providing consultation as needed and to advise staff members with respect to maintenance of a satisfactory quality of treatment.

   (5)  Prior to the performance of any abortion, appropriate methods shall be used to determine positive evidence of pregnancy by test result, history, and physical examination, or other reliable means; and such findings shall be entered in the medical record of the patient.

   (6)  Prior to the performance of an abortion, the attending physician shall insure that the patient has had tests for hemoglobin or hematocrit, blood group and RH type, and urine protein and sugar. All of the foregoing laboratory results shall be entered in the medical record of the patient.

   (7)  Rho (D)—immune globin (human) shall be administered to each Rh-negative patient at the time of any abortion, unless contraindicated. Evidence of compliance with this paragraph shall appear in the medical record of the patient. If for any reason the patient refuses the administration of Rh immune globulin when recommended, this refusal shall be noted in the clinical record of the patient.

   (8)  When there is an abortion performed during the first trimester of pregnancy, the tissue that is removed shall be subjected to a gross or microscopic examination, by the physician or a qualified person designated by the physician to determine if a pregnancy existed and was terminated. If the examination indicates no fetal remains, that information shall immediately be made known to the physician and sent to the Department within 15 days of the analysis. If the examination indicates no fetal remains or villi, the physician shall immediately inform the patient of the possibility of an ectopic pregnancy and shall recommend appropriate follow-up. When there is an abortion performed after the first trimester of pregnancy which the physician has determined as not viable, all such tissue removed at the time of the abortion shall be submitted for tissue analysis to a board eligible or certified pathologist. If the report reveals evidence of viability or live birth, the pathologist shall report such findings to the Department within 15 days and a copy of the report shall also be sent to the physician performing the abortion. The findings of the gross or microscopic examination shall be entered in the medical record of the patient. Each facility, including the hospital, shall provide treatment or referral for treatment of any diagnosed pathological condition.

   (9)  Each medical facility is encouraged to offer contraceptive services to patients. Both optional contraceptive counseling and supportive counseling, as needed by patients, shall be offered and made available on the premises or through referral.

   (10)  Each freestanding clinic shall have a written transfer agreement. The agreement shall be entered into with a hospital which is capable of providing routine emergency services as defined in this subchapter. For the purpose of this subchapter, routine emergency services will include but not be limited to the following:

     (i)   A physician at all times in the hospital available to provide emergency services.

     (ii)   Either full surgical or full obstetrical and gynecological surgical capability, including anesthesia, available for use within 30 minutes notice.

     (iii)   Blood bank, clinical laboratory and diagnostic radiological services for use within 30 minutes notice.

       (A)   This paragraph also applies to any hospital or part thereof which does not provide routine emergency services.

       (B)   In the case of a hospital satellite clinic, where the hospital does maintain an adequate emergency service on its main grounds, this paragraph will be deemed met if the hospital has and operates under policies and procedures which ensure transfer of patients with complications from the satellite clinic to such emergency services.

       (C)   The location of the hospital holding the agreement to supply emergency services shall not be farther than 30 minutes by ambulance from the clinic.

   (11)  When general anesthesia or major regional anesthesia blockade, including spinal or epidural anesthesia, is utilized, it shall be administered by a second physician, or a nurse anesthetist under appropriate supervision. Local anesthesia, including para-cervical block, may be administered by the physician performing the abortion.

   (12)  Each medical facility shall maintain a list of persons permitted to administer anesthesia under paragraph (11) and shall develop and maintain written policies governing the responsibilities of the persons and written procedures governing the administration of the anesthesia.

   (13)  Each patient shall be supervised constantly while recovering from surgery or anesthesia, until she is released from recovery by a registered nurse or a licensed practical nurse under the direction of a registered nurse or a physician. The nurse shall evaluate the condition of the patient and enter a report of the evaluation and orders in the medical record of the patient.

   (14)  Corridor doors, elevators, and other passages shall be adequate in size and arrangement to allow a stretcher-borne patient to be moved from each procedure room and recovery room to a street-level exit.

   (15)  All tissues obtained from abortions not subject to paragraph (8) shall be refrigerated, frozen, submersed in a proper preservative solution, and transported to a hospital, laboratory or incinerator on a regular basis for disposition.

Cross References

   This section cited in 28 Pa. Code §  29.38 (relating to reports).



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