L HOSPITAL iytatuJardt and TfeyuMiom DIVISION OF HOSPITAL FACILITIES KANSAS STATE BOARD OF HEALTH-TOPEKA V '■» * '' Standards and Regulations for Hospitals in Kansas KANSAS STATE BOARD OF HEALTH • • • TOPEKA DIVISION OF HOSPITAL FACILITIES F. C. BEELMAN, M. D., Secretary and Executive Officer FOREWORD • • The Commission on Hospital Care, an independent non-govern- mental committee, recently made an exhaustive study and analysis of the hospital situation in this country. The Commission’s report, published by the Commonwealth Fund under the title, “Hospital Care in the United States,” makes, among many others, the follow- ing recommendations: “All institutions providing overnight care to the sick should be licensed to operate and should be subject to periodic inspection by state authority. “Hospital licensure law should be used as a means to develop an effective, economic, integrated hospital service which will adequately supply the public’s needs.” Although certain phases of hospital care have long been super- vised in many states, the movement toward state licensing and in- spection of all hospitals is recent and, generally supported by hos- pital, medical, and health organizations, has spread rapidly. The Kansas legislature adopted a licensure law in 1947, and created an Advisory Hospital Council to work with the Board of Health in ad- ministration of the law. The Board of Health accepts the responsibility of formulating standards, rules and regulations for hospitals with confidence that Kansas Hospital Administrators themselves are, more than any others, interested in the efficient and successful operation of their institutions, and are constantly striving to improve their service. Such regulations as the Board may make, with the approval of the Advisory Hospital Council, are expected to serve as an operating guide; and the standards recommended herein are intended pri- marily to remind those who obtain licenses to conduct hospitals that vigilance, diligence and a humanitarian attitude are essentials in the proper care of patients. In adopting these standards and regulations, the Board of Health has tried to give due consideration to differences in size, type, and resources of hospitals and to make requirements for licensure rea- sonable and flexible. Secretary and Executive Officer Kansas State Board of Health KANSAS ADVISORY HOSPITAL COUNCIL John L. Grove, M. D., Newton Irma Law, R. N., Emporia Mr. Mont Green, Manhattan Mr. Charles Newell, Kansas City Sister Mary Anne, R. N., Pittsburg Zelma Smith, R. N., Russell Mr. Merton Earl, Topeka James D. Bowen, M. D., Topeka Mr. Ray Pierson, Burlington F. C. Beelman, M. D., Topeka Ex officio Secretary R. M. Heilman, M. D., Division of Hospital Facilities BOARD MEMBERS KANSAS STATE BOARD OF HEALTH G. I. Thacher, M. D., Waterville R. T. Nichols, M. D., Hiawatha John M. Porter, M. D., Concordia J. F. Gsell, M. D., Wichita G. R. Hastings, M. D., Garden City Hugh A. Hope, M. D., Hunter F. L. Loveland, M. D., Topeka L. S. Nelson, M. D., Salina J. W. Spearing, M. D., Columbus William E. Scott, Kansas City 3 CONTENTS • • PAGE Purpose of Licensure Law 5 Standards and Regulations 7 Institutions to Be Licensed 7 I. New Construction, Material Alterations, Additions 7 Sites 8 II. General Standards A. Safety and Sanitation . 8 B. Dietary Department 10 C. Accommodations for Patients 11 D. Nursing Department 12 E. Hospital Records and Reports 14 F. Provision for Contagious Disease Patients 15 G. Laboratory Facilities and Practices 15 H. X-ray Facilities 15 I. Personnel 15 III. Special Requirements for Maternity Service A. Nursing Service 16 B. Accommodations for Maternity Patients 16 C. Provisions for the Patient in Labor 17 D. Provisions for Delivery 17 Care of Newborn Infants 18 E. Accommodations for Infants and Nursery Care 18 IV. Special Requirements for Mental Hospitals A. Personnel 21 B. Security Measures 21 C. Restraints 21 D. Shock Treatment 21 V. Special Requirements for Tuberculosis Hospitals A. Disposal of Sputum 22 B. Contagion Technique 22 C. X-ray Department 22 D. Dishwashing 22 E. Rehabilitation Facilities 22 VI. Hospital Standards Developed on a Point System Explanatory 22 Point Schedule 23 VII. Licensure Law 31 Inquiries addressed to Division of Hospital Facilities, Kansas State Board of Health, Topeka, Kansas, relative to regulations or to codes, officers, or organizations referred to herein will re- ceive prompt attention. PURPOSE • • of the Licensure Law An act providing for the licensing, inspection and regulation of hospitals and for administrative and enforcement procedures went into effect upon publication in the Statute Book, June 30, 1947. A copy of the act, which may be referred to as the “Licensure Law,” is appended hereto. The State Board of Health, subject to advice and direction of the Advisory Hospital Council, is charged with administration of the law. The “Licensure Law” (Chapter 329, Laws of Kansas, 1947) sets forth the purpose of the act in Section 2, viz.: “To provide for the development, establishment, and enforcement of standards: (1) for the care and treatment of individuals in hospitals, and (2) for the construction, maintenance, and operation of hos- itals, which . . . will promote safe and adequate treat- ment of such individuals in hospitals.” The law creates an Advisory Hospital Council, which “shall have the following responsibilities and duties: (a) To supervise and direct the Licensing Agency (State Board of Health) in matters of policy affecting administration of this act, and in the development and approval of rules, regulations and standards provided for hereunder. (b) To review on appeal . . . any order of the licensing agency revoking, denying or suspending a license and to modify or reverse such order” (Section 11). The following “Standards and Regulations” are adapted from standards prevailing in many states which have a licensure law similar to ours. A large majority of Kansas hospitals have won favorable recognition by national medical associations. To them, such regulations may appear merely as a reflection of something already accomplished. We hope, however, by setting up reason- able standards and by raising them in keeping with further advances in medical science, to call attention to inadequacies or defects in hospital practices and facilities and to furnish a guide for constant improvement—all to the end that those who need medical care may 5 find safe, comfortable accommodation, and scientific and ethical treatment in any Kansas hospital. We solicit the active cooperation of Hospital Boards, Medical Staffs, Nurses, other Personnel and State Agencies concerned, in using the Licensure Law as an aid in attaining and maintaining the highest standards of Hospital Service. F. C. Beelman, Secretary and Executive Officer Kansas State Board of Health R. M. Heilman, M. D., Director Division of Hospital Facilities Standards, Regulations, and Recommendations Those parts having the effect of law are printed in boldface type Institutions Subject to Licensure Under Chapter 329, Laws of Kansas, 1947 General Hospitals Hospitals providing general medical or surgical care. They may or may not also provide specialized services such as pediatrics, maternity, and urology. Hospitals limiting their services to special types of care, such as tuberculosis, orthopedics, pediatrics. Special Hospitals Hospitals or Homes For the Chronically 111 or Convalescent Nursing homes, rest homes, convalescent homes, or other institutions devoted primarily to the maintenance and operation of facilities for the care or treatment of four or more patients suffering from prolonged illness or defect, or recovering from injury or disease and receiving medical or skilled nursing care. (Such homes are to be distinguished from institutions which are devoted primarily to domiciliary care.) I. New Construction, Material Alterations, Additions 1. As one of the primary purposes of the Licensure Law is to develop, es- tablish, and enforce standards for the construction of hospitals, close co- operation between the Board of Health (the licensing agency), the hosiptal management (or owner) and those in charge of such construction (archi- tects and contractors) is particularly desirable when new buildings, addi- tions or material changes are in prospect. Before construction is begun, plans and specifications covering the con- struction of new buildings, additions, or material alterations to existing buildings shall be submitted to the Board of Health for approval or rec- ommendations with respect to compliance with these standards and regu- lations. These plans should show the general arrangements of the build- ings, including the intended purpose and fixed equipment of each room, with such additional information as the Board of Health may require. Thereupon the Board of Health will investigate the plans and give notice to the proper person, of approval or disapproval with such recommenda- tions as it sees fit to make. No system of water supply, plumbing, sewerage, garbage or refuse disposal for these institutions shall be installed nor shall any such existing system be materially altered or extended until complete plans and specifi- cations for the installation, alteration or extension, together with such in- 7 formation as the Board of Health may require, have been submitted in dulpicate and approved. Construction should follow approved plans and specifications. It is suggested that in order to avoid unnecessary expense in changing final plans, proposed plans in sketch form be reviewed with the Board of Health as a preliminary step. 2. Sites for new construction should be selected with a view to both present and continuing desirability. Environment, zoning restrictions, accessibility, and availability of public utilities will be taken into consideration in examin- ing applications for license. 11. General A. SAFETY AND SANITATION 1. Cleanliness Clean, well-kept buildings are essential. Floors, walls, and ceilings should have finishes suitable for purpose for which room serves and should be frequently washed, cleaned or painted. Comfortable and sanitary living conditions for patients and employes should be main- tained. 2. Fire Protection Provision for protection against fire, explosion, spontaneous combus- tion, toxic, noxious or irritating gases is essential and must satisfy the requirements of the State Fire Marshal, and of existing local agencies for fire prevention and fire control. 3. Heating Heating plant shall be adequate to maintain a temperature of 70 de- grees Fahrenheit in severe weather, in all rooms used for patients, and capable of maintaining a temperature of 75-85 degrees Fahrenheit in nurseries. 4. Water Supply The water supply shall be obtained from a water supply system, the location, construction, and operation of which comply with the stand- ards approved by the Board of Health. It is recommended that a municipal water supply be used if available. The water should be distributed to conveniently located taps in the building and hot water made available at all times. 5. Sewage Disposal Sewage shall be discharged into a municipal sewerage system where such a system is available; otherwise, the sewage shall be collected, treated, and disposed of in an independent sewerage system which complies with the standards approved by the Board of Health. 6. Plumbing Toilet facilities in reasonable ratio to the number, type, and sex of patients cared for in the institution are necessary. The plumbing and drainage, or other arrangements for the disposal of excreta, infectious discharges, and institutional waste, shall be designed in a manner that will not permit contamination of any water supply, milk or other food materials. These standards prohibit the use of any fixture connected to the plumbing system that is of such design, or installed in such manner, as to permit back siphonage of contaminated products into the water lines. Disposal shall be such as to protect against access thereto of rodents, flies or other insects, and not to permit untreated discharges of sewage to contaminate or intermingle with any flood, surface or ground water. 7. Garbage Disposal All garbage shall be collected, stored, and disposed of in a manner that will not permit the transmission of a contagious disease, create a nuisance or provide a breeding place for flies. Containers for garbage should be water-tight, have tight-fitting covers, and be fly and rodent proof. They should be emptied at frequent intervals and be scoured and aired before further use. Infectious waste materials shall be burned on the premises. 8. Screens When flies, mosquitoes, and other insects are prevalent, all outside doors, windows, and other outside openings shall be screened with wire screen or its equal, with not less than sixteen meshes per lineal inch. All screen doors should open outward where building design permits and be equipped with self-closing devices. 9. Lighting Adequacy—Each patient’s room shall be an outside room with a satis- factory amount of natural light. The window area should not be less than one-eighth of the floor space. All rooms, including storerooms, attic, and basement areas in use, should have sufficient artificial light- ing facilities so that all parts shall be clearly visible under such artificial lighting. It is especially important that hallways, stairways, inclines, ramps, and entrances be well lighted in order to prevent accidents. Lighting fixtures should be selected and placed with a view to the comfort and safety of patients and personnel. All service rooms and working centers, such as medicine cabinets or nurses’ charting desks should be adequately lighted. Type and installation of fixtures in operating, anesthesia, and delivery rooms must be such as to minimize danger of explosion. Grounded explosion-proof receptacles shall be provided. 10. Emergency Lighting Emergency lighting facilities must be provided and distributed so as to be readily available to personnel on duty. Flashlights or battery operated lamps, with vapor-proof switches, providing ample illumina- tion for surgery, shall be in readiness at all times for use in delivery and operating rooms. At no time may open flame type of light be used in delivery or operating rooms. 9 11. Ventilation Building shall at all times be adequately ventilated. Kitchen, bath- rooms, and service rooms should be so located and ventilated by window or mechanical means as to prevent offensive odors from entering patients’ rooms and the public hallways. 12. Stairways All stairways shall be provided with handrails; open stairways with guardrails. Nonslip treads are recommended. 13. Elevators Elevator installation shall comply with local and state codes, if any, and with requirements of State Fire Marshal. Passenger cab platforms should be not less than 5' 4" XB' 0". Doors should be not less than 3' 10" wide. 14. Laundry The institution shall make provision for the proper cleansing of linen and other washable goods. Diapers and other soiled nursery linen should be washed separately from each other and from other hospital linen. It is especially important that diapers be washed with plenty of mild soap, and thoroughly rinsed through four waters to remove all soap. Where linen is sent to an outside laundry it is the responsibility of the institution to visit the laundry selected and determine that work is done in accordance with these standards. 15. Incineration Incineration facilities shall be provided for the disposal of infected dressings, surgical and obstetric wastes, and other similar materials. 16. Communication There must be a telephone in the building. Telephone extensions or other means of intercommunication should be provided. B. DIETARY DEPARTMENT 1. Facilities for Preparation and Serving of Food There must be facilities for the proper preparation and serving of food. Hot, well-balanced meals shall be served regularly. 2. Food Storage (a) Storerooms—Storerooms shall be clean and well ventilated. Stored food should be protected from dust, flies, rodents, vermin, unnecessary handling, droplet infection, overhead leakage or other source of con- tamination. (b) Refrigeration—Kitchen facilities shall include refrigeration, and perishable food must be kept at a temperature below 50 degrees Fahren- heit. It is suggested that there be a reliable thermometer in the re- frigerator and in the storerooms used for perishable food. 3. Cleansing and Disinfection of Utensils All dishes and utensils used in storage, preparation or serving of food and drink shall be effectively cleansed, rinsed, and disinfected after each usage. Recommended methods of disinfection: (1) Immersion for at least 2 minutes in clean water at 170° Fahrenheit. (2) Immersion for at least one-half minute in boiling water. (3) Immersion for at least 2 minutes in lukewarm chlorine bath con- taining at least 50 parts per million of available chlorine. (Chlorine is not recommended for silverware.) Results obtained with dishwashing machines should be equal to those obtained by the methods outlined above. After disinfection, the utensils should be allowed to drain and dry in racks or baskets on nonabsorbent surfaces. Drying cloths are not recommended. Dishes should be stored in closed cupboards for pro- tection against dust and moisture. 4. Construction of Glass-filling Devices Every device for filling water glasses should be constructed so as to prevent contact of the upper one-third of the glass with the device, and in addition, so that no portion of the device extends into the glass. 5. Ice All ice used in contact with food or drink shall be clear natural ice, or ice made from water from a source approved by the Board of Health. Before ice is used in food or drinks it shall be washed with water of known safety, and handled in such manner as to prevent contamination by organisms of infectious disease. 6. Milk Supply Grade “A” pasteurized milk must be used if available. When such milk is not available, condensed, evaporated, or dried milk is recommended. Every precaution should be taken to assure a supply of safe, good milk. 7. Hand-washing Facilities for Food Handlers There shall be hand-washing facilities with soap, running water, and an adequate supply of towels in all kitchens, including diet kitchens, and in washrooms used by food handlers. Use of a common towel is prohibited. C. ACCOMMODATIONS FOR PATIENTS 1. Rooms (a) Location—Each patient’s room shall be an outside room with a satisfactory amount of natural light and shall communicate directly with a corridor. Rooms extending below ground level shall not be used for patients unless they are dry, well ventilated, and otherwise suitable for occupancy. (b) Room Area—Rooms shall afford not less than 60 square feet of floor space per bed with at least 3 feet between beds. Recommended: At least 100 square feet in one-bed rooms and 80 square feet per bed in multiple-bed rooms. 11 (c) Window Area—Window area should not be less than one-eighth of the floor area. Half of window area should be openable. (d) Doors— Doors to patients’ rooms should open inward and be suffi- ciently wide to permit easy removal of an occupied bed. (3' 10" is recommended.) 2. Furnishings (a) Bed—A good bed must be provided for each patient. After dis- charge of any patient the bed and bed furnishings, bedside furniture, and equipment shall be thoroughly cleaned. (b) Bedding—A sufficient supply of clean bedding and bed linen shall be kept on hand for use at all times. (c) Storage Space—There should be satisfactory storage space for clothing, toilet articles, and other personal belongings of patients. (d) Privacy for Patients—Where two or more patients occupy the same room, privacy shall be secured by means of screens or suspended cur- tains. (e) Signals—Means for signaling attendants shall be provided at the bedside of each patient. D. NURSING DEPARTMENT 1. Space Requirement There shall be adequate space and facilities for the proper cleansing and storage of nursing supplies and equipment. Suitable provision must be made for the preparation of medications and treatments. Utility rooms should be outside rooms with adequate lighting and ventilation. They should be conveniently located for efficient conduct of work. 2. Equipment There should be sufficient equipment for nursing care according to the type of patients accepted by the institution. The following is not a complete list of nursing equipment necessary or desirable for the care of patients, but is intended to include certain minimum essentials and point out special precautions which must be taken in their use. (a) Linen—lndividual towels, wash cloths, and bath blankets must be provided for each patient. Bedpan covers must not be used interchangeably. (b) Enameltvare—There shall be sufficient number of wash basins, mouthwash cups, and bedpans, plainly marked, for the use of each individual patient; provided that where enamelware is disinfected or sterilized after each using, it need not be kept individual. (c) Thermometers—There shall be a sufficient number of thermometers, both oral and rectal, to permit adequate disinfection before using. (d) Hot-water Bags—Hot-water bags should be covered before placing in beds. The greatest care should be exercised in their use to see that water is not too hot and bags are not leaking. If electric heat pads are used, they shall be checked periodically by a qualified electrician. (e) Restraints—Restraints may be applied only when they are neces- sary to prevent injury to the patient or to others, and should be used only when alternative measures are not sufficient to accomplish these purposes. In applying restraints, careful consideration should be given to the methods by which they can be speedily removed in case of fire or other emergency. 3. Storage of Drugs and Medicines (a) All medicine, drugs, poisons, and stimulants shall be plainly labeled and stored in a specially designated, well-lighted medicine cabinet, closet or storeroom, and made accessible only to the physician or nurse in charge. (b) Narcotics must be securely locked and accessible only to the per- son in charge. Biologicals shall be kept under refrigeration at tempera- ture of 50 degrees Fahrenheit or under. (c) Old medications should be discarded, including special prescrip- tions for patients who have left the institution. 4. Sterilization of Supplies (a) Sterilizing Equipment—There shall be provision for the proper sterilization of dressings, utensils, instruments, and water. (b) Check of Sterilizer Performance—lt is recommended that a hospital adopt a recognized method of checking sterilizer performance, such as the use of a fusing control in the largest package of each load, or the bacteriological examination, at frequent intervals, of sterilized dressings. (c) Storage of Supplies—A cabinet or other suitable enclosed space should be provided for keeping sterile equipment and supplies. Special precautions must be taken so that sterile supplies may not be mixed with unsterile supplies. 5. Hand-washing Facilities (a) There should be adequate hand-washing facilities throughout the institution, especially in operating, delivery, and labor rooms; in exam- ining and treatment rooms; in main and diet kitchens; in utility and other service rooms; in toilet rooms; in rooms used for isolation of pa- tients; and in nursery. Lavatories in patients’ rooms are desirable. (b) Special Features in Connection with Scrub-up Sinks—To be well adapted for hand-scrubbing for personnel, hand-scrubbing sinks should be designed to make it possible to wash hands easily, comfortably, and without breaking technique. (1) The lavatory or sink should be at a proper height from the floor. (2) Faucets should be high enough above the basin to permit easy hand-washing under running water without touching the sides of the basin. Mixing faucets are desirable. (3) Running water for scrub-up sinks should be controlled with a foot, elbow or knee device. (4) A sufficient supply of linen or paper towels shall be constantly available so that a fresh towel can be used for every hand-washing. Use of a common towel is prohibited. 13 E. HOSPITAL RECORDS AND REPORTS 1. Medical Records Accurate and complete medical records shall be kept for all patients admitted to the hospital, including a record of admission date, physical examination, provisional diagnosis, treatment, prognosis, and nursing care. The records of cases involving surgery must show details of pre- operative study and diagnosis; name of surgeon and his assistants, type of anesthetic and by whom administered; postoperative diagnosis, pathology, and result. Records of newborn infants shall be kept and shall contain the physi- cian’s signed report on the physical condition of the infant immediately before the infant is discharged from the hospital. All hospital records shall be preserved in a permanent file either as original records, abstracts, microfilming or otherwise, and should be such as to afford a basis for a complete audit of professional service rendered and for gathering statistical information. 2. Physicians’ Orders All orders of physicians shall be written in ink or indelible pencil and signed by the physician in charge. Such orders shall be preserved on the patient’s chart or in the established record of such orders. 3. Financial Records An accurate and complete record of income and disbursement shall be maintained. Recommendations of hospital associations regarding ac- counting and statistics deserve careful consideration. 4. Birth and Death Lists On or before the fifth day of each month a complete list of births, deaths, and stillbirths occurring in the hospital during the preceding calendar month shall be reported to the Board of Health with such information as the board requires, on special blanks which the board will furnish for such purpose. 5. Birth and Death Certificates (a) The hospital shall prepare a birth certificate for every child born therein, obtain attending physician’s signature thereon, and forward it to the local registrar of vital statistics within five days after date of birth. (b) Upon the death of a patient the hospital must promptly prepare a standard Kansas certificate of death for the deceased, containing all personal particulars, medical certification of cause of death and physi- cian’s signature. This complete death certificate will be presented to the funeral director or other person authorized by the family to prepare the body for interment. 6. Disposition of Bodies Whenever the body of a stillbirth or deceased is to be disposed of in any hospital by incineration, preservation or dissection, the hospital is legally acting as an undertaker and therefore must comply with section 134 of the vital statistics law (Ch. 65, Secs. 130-151, G. S., 1935). Such compliance involves filing a standard stillbirth or death certificate with the local registrar of vital statistics and obtaining a burial-removal per- mit before disposing of the body by the aforementioned means. 7. Unclaimed Bodies The hospital, when in possession of a dead body which is unclaimed, shall promptly notify the University of Kansas Medical Center, Kansas City, Kansas, of such possession. (See Ch. 65, secs. 901-905, inch, and Sec. 1706, G. S., 1935, for laws governing use of dead bodies by schools.) F. PROVISION FOR CONTAGIOUS DISEASE PATIENT Hospitals which do not have a specialized contagious disease department shall make adequate provision for isolation of patients with contagious disease, or suspected of having, or being carriers of contagious disease. G. LARORATORY FACILITIES AND PRACTICES Hospitals shall provide, as a minimum, adequate space, equipment, and supplies for routine chemical and microscopic urinalysis; and for complete blood count, coagulation time, bleeding time, sedimentation rate and esti- mation of hemoglobin. Such facilities should be supervised by a physician. Hospitals which do not maintain a laboratory capable of making standard hematological, bacteriological, pathological, and chemical diagnostic exami- nations under supervision of a competent pathologist, shall arrange to ob- tain all such service from a laboratory approved by the Kansas Advisory Laboratory Commission. All abnormal tissues removed at operation, except tonsils and adenoids, shall be examined by a pathologist. Complete reports of results of laboratory tests and of examinations of tissues shall be entered in patients’ records. H. X-RAY FACILITIES Adequate space and equipment should be provided for diagnostic X-ray and fluoroscopic examinations. X-ray work should be in charge of, or under the general supervision of, a licensed physician with training or experience in radiology, who should assume responsibility for film interpretation and for proper protection against radiation, electric shock, and combustion of stored film. I. PERSONNEL 1. Medical Attendance and Nursing Service (a) All persons admitted to a hospital should be under the care of a physician duly registered and licensed in Kansas, and authorized by the governing body to practice in such hospital. A diagnosis or provisional diagnosis should be recorded promptly by the physician on all persons admitted. Consultation on all serious cases by use of various medical staff members should at all times be encouraged. 15 (h) No medication or treatment shall be given to a patient except on the written order of a physician. When emergency cases are given medication upon oral or telephone instructions, the instructions should he written into the record. (c) In all hospitals which admit two or more doctors to practice there should be an organized staff to govern the practice of medicine in the hospital and complete records of the proceedings of such organization should be maintained. All techniques and procedures involving diag- nosis, treatment, and management of the patients should be reviewed periodically and subject to change by the medical staff. (d) Nursing service should be in charge of a registered nurse, day and night. Provision should be made for adequate nursing coverage at all times. (e) Homes or hospitals for chronically ill or convalescent patients shall arrange for one or more regularly licensed physicians to be called in emergency. They should have one qualified person, preferably a registered nurse, definitely in charge of nursing service. (f) All adjunct and specialized services including laboratory, anes- thetics, urology, radiology, etc., should be under direction of a qualified staff physician. 111. Special Requirements for Maternity Service A. NURSING SERVICE Nurses caring for maternity patients and newborn infants should not care for other patients. When necessary for the same nurse to care for both maternity and nonmaternity patients, isolation technique shall be employed in giving nursing care. All personnel in contact with patients and all food handlers should be examined on assignment and annually thereafter by a physician designated by the hospital management, and certified as showing no evidence of com- municable disease. B. ACCOMMODATIONS FOR MATERNITY PATIENTS 1. Segregation of Department It is recommended that maternity patients be cared for in a segregated part of the hospital. If it is necessary to place maternity patients in rooms previously occupied by other patients, rooms and furnishings shall be thoroughly cleaned before so used. 2. Isolation Facilities Immediate segregation and isolation of all mothers with infection, fever or other condition inimical to the safety and welfare of others must be provided in a separate room. 3. Patients’ Room Rooms for maternity patients must in general conform to the require- ments set forth in Section 11, C-l, of these standards. The following are additional requirements for rooms housing maternity patients: (a) Location—All rooms occupied by maternity patients shall be non- basement rooms. (b) Floor Area—Rooms or wards in which maternity patients are cared for shall provide floor space equal to at least 70 square feet per patient. There shall be at least 3 feet between beds. (c) Privacy—Where two or more patients occupy the same room, pri- vacy shall be secured by means of screen or curtains. (d) Hand-washing Facilities—lf the patient’s room serves as admission and preparation room, it shall be equipped with proper hand- washing facilities. D. PROVISION FOR DELIVERY 1. Room to Be Provided (a) It is recommended that a special room be equipped as a delivery room. This room must not be used for any other purpose, and it should be used only for delivery of noninfected patients. Patients with any evidence of infection or possible infection should be delivered in a separate room or in a private room. (b) If maternity service is very small, it is permissible to use patient’s own room provided the room affords reasonable privacy, can be set up satisfactorily for delivery, and is thoroughly cleaned before use. (c) The operating room should not be used for delivery with the ex- ception of Caesarean section. 2. Room—Physical Features (a) Delivery room shall be of ample size to permit observance of good technique. (b) Walls and floor must be washable. (c) Adequate lighting shall be provided. (d) Hand-scrub facilities for doctors and nurses shall be in or adjacent to delivery room. 3. Equipment—For Delivery (a) There should be a suitable delivery table equipped for operative deliveries and treatment of shock. The pad should be protected with waterproofed sheeting in good condition. (h) Delivery room should be furnished with suitable tables or stands for instruments, enamelware, and necessary supplies. (c) An adequate supply of enamelware and sterile linen, dressings, gloves, and face masks should be in readiness for all deliveries. (cl) Facilities for administration of oxygen and sterile equipment for administration of blood transfusions and intravenous or subcutaneous therapeutic solutions must be readily available. (e) There shall be ready at all times equipment for general anesthesia, and a minimum of drugs and anesthetics ordinarily needed for use. (/) A stretcher or carrier must be provided for returning patient to her own room. 17 (g) There should be a surgical or spot light, a small sterilizer, and a clock in the delivery room. All lights should be equipped with ex- plosion-proof bulbs. (h) There should be a supply cabinet or built-in shelf for sterile pack- ages, instruments, suture materials, oxytocic drugs, syringes, and emer- gency equipment. (i) The same aseptic technique shall prevail as at any surgical op- eration. Equipment—For Reception of Newborn Infant (a) Heated Bassinet—A heated bassinet, crib or incubator shall be ready in the delivery room for reception and care of the newborn infant. Provision should be made for keeping the infant warm and protected from exposure to infection during transit from delivery room to nursery. If the infant is carried by a nurse, he should be wrapped in a warm blanket and the nurse should wear a mask and a gown. An elevator, when used by an attendant transporting an infant, should be free of other passengers. (b) Equipment for Resuscitation—There must be equipment for re- suscitation as ordered by the physician. Facilities for the administra- tion of oxygen shall be available. (c) Silver Nitrate Ampoules—Silver nitrate ampoules for the prevention of infant blindness shall be kept on hand and instillation of silver nitrate shall be done before the infant is removed from the delivery room. (d) Identification of Newborn Infants—Every infant shall be marked for identification before it is removed from the delivery room by one of the reliable methods in common use, such as tape or name beads. In- formation shall be sufficient to identify infant with one mother, and one only. If written tags are used, ink shall be waterproof. 4. Provision for Postpartum Mothers Immediate Care After Delivery—The patient shall be under close super- vision during the time when she is recovering from the effects of anes- thesia and for at least one hour to observe the fundus and to report to the physician any symptoms of hemorrhage. E. PROVISION FOR INFANTS 1. Nursery Unit (a) Nursery to Be Provided—A nursery shall be provided for the care of newborn infants which shall not be used for any other purpose, ex- cept that infants may be kept in mothers’ rooms provided individual cribs are furnished, visitors restricted, and other conditions are satis- factory to the Board of Health. (b) Activity Units—lt is recommended that the total nursery space be divided into units in order to segregate the routine activities, such as preparation for work in the nursery, bathing and dressing of infants, preparation of feedings or examination by physician. In existing nurs- eries where such division of space into unit-rooms is not feasible, facili- ties and equipment may be arranged to permit separation of the several nursery activities by areas of the room. (c) Segregation and Isolation of Infants. (1) Infants with infections—lmmediate segregation and isolation of all infants with infections such as respiratory infections, skin rash or diarrhea, shall be provided in a separate room. All equipment shall be kept completely separate for each infant. (2) Infants born outside hospital—lnfants born outside hospital shall be isolated for at least 72 hours after admission. 2. Rooms—Physical Features (a) Location—Nursery should be an outside room so located as to re- ceive sunshine some portion of the day. It is recommended that it be on the same floor as, and conveniently located with reference to the mothers’ rooms. (b) Size and Construction All-activity room—All-activity rooms (combined sleeping and bathing rooms) should have sufficient floor area to permit spacing of cribs at least six inches apart, plus adequate space for necessary supplies and equipment and for giving nursing care. There should be ample aisle space between rows of cribs. The all-activity room should have at least 20 square feet of floor space per infant (24-30 square feet recommended), and at no time should this be less than 16 square feet of floor space per crib. (c) Hand-scrub Facilities—There should be hand-scrubbing facilities in the nursery. Running water should be controlled by foot, knee or elbow device. (d) Control of Atmospheric Conditions (1) Heating—Heating equipment shall be sufficient to maintain a temperature of 75-85 degrees Fahrenheit. Any room used for the care of infants should be provided with a reliable room thermometer near the cribs, and approximately at crib level. (2) Humidity—An instrument for measuring humidity is desirable in sleeping rooms. If air is too dry, means should be pro- vided for maintaining desirable humidity. (3) Ventilation—Glass deflectors, or other effective window venti- lators, are recommended as protection against dust and drafts. (e) Walls, Floors, and Ceilings—Walls and floors must be washable. Dry sweeping or dusting is prohibited. Accoustical ceiling treatment is recommended, unless nursery is in a separate wing, or otherwise well separated from rooms of patients. (/) Viewing Window—A glass observation window is recommended. Where bathing and sleeping rooms are combined, shades, screens or Venetian blinds are suggested to shield the infants from view during care or examination. 19 3. Furnishings and Equipment (a) Bassinets—A separate crib or basket shall be provided for each in- fant. Cribs shall have firm mattresses, covered with water-proof sheet- ing and washable pads. Washable inside linings must be provided to obviate danger of injury to infants from crib bars, and as a preventive measure against transmission of infection. Freshly laundered linings, blankets, and linen shall be furnished for each new occupant. (b) Work Table—Where a common bathing table is in use, it shall be properly protected and the pad covering renewed after each bath. If basins are used, a separate one must be provided for each infant or the basin must be sterilized before each use. (c) Scales—Accurate scales must be provided. (d) Medication Tray—All bottles should be clearly labeled, and old medications discarded. (e) Hot-water Bags—li hot-water bags are used, they must be covered with a protective covering before being placed in the crib. Electrical heating pads shall not be used in cribs of infants. (/) Diaper Cans and Linen Hampers—ln each nursery there shall be at least one covered metal container for soiled diapers, with foot control pedal and removable paper or other lining which can be disposed of or laundered. In each nursery there shall be at least one linen hamper with removable bag for soiled linen other than diapers. (g) Rectal Thermometers—One rectal thermometer shall be provided for each infant. Thermometer shall be kept in antiseptic solution in individual containers, unless satisfactory provision is made for disin- fection. (h) Incubators—lncubators suitable for the care of premature infants shall be provided in the ratio of at least one incubator to 20 bassinets, or fraction thereof. (A study of “New Standards for Care of Premature Infants,” adopted by the Board of Health, is recommended.) (i) Clock—A large wall clock, visible from all parts of the nursery, should be provided. 4. Preparation of Feedings (a) Milk Room—There shall be a special space for the preparation of milk mixtures, equipped with a sterilizer, refrigerator, sink, and hand washing facilities. (b) Milk Supply—lt is advised that all milk not canned or powdered be boiled for infants. (c) Refrigeration—lced water should be available for cooling bottles containing milk mixtures before refrigeration. There shall be a re- frigerator equipped with a thermometer and large enough to hold a 24-hour supply of individually bottled milk mixtures. A temperature of 40-45 degrees Fahrenheit should be maintained in the refrigerator. (d) Care of Bottles, Nipples, and Utensils—Bottles, nipples, and utensils used in the preparation of milk mixtures shall be thoroughly washed and sterilized before each use. Feeding equipment from infected or suspected infants shall be sterilized before it is returned to the milk room. Provision for warming the bottles before feeding should be made in the milk room. (e) Preparation of Feedings— Milk mixtures should be prepared by a registered nurse or dietitian. Scrupulous adherence to aseptic tech- niques in preparation of feedings is vitally important. 5. Clothing and Linen (a) Clothing—lt is recommended that infants’ clothing be furnished by the hospital. If furnished by the mother, precautions must be taken to avoid introduction of vermin or infection into the nursery. Freshly laundered or destroyable diapers only shall be used and shall be avail- able in necessary quantity. (b) Laundry—Nursery linen should be washed separately from other hospital linen, and care taken to avoid contamination of freshly laun- dered articles. Clean receptacles only shall be used to return nursery linen to the maternity department. Diapers shall be washed in plenty of mild soap and thoroughly rinsed through four waters to remove all soap. IV. Special Requirements for Mental Hospitals A. PERSONNEL The staff of a mental hospital or general hospital with psychiatric service should include a physician who is qualified by training and experience to direct the care and treatment of patients afflicted with mental illness. Psychiatrists and other personnel, trained in therapies used in the care or treatment of the mentally ill, should be proportionate to the number of patients as recommended by the American Psychiatric Association. B. SECURITY MEASURES Hospitals admitting and treating mentally-ill patients shall take every reasonable precaution for the security of patients and personnel, such as providing lockable doors and windows, screens or bars, shatter-proof glass, suitable room furnishings, etc., and exercising due diligence in keeping drugs, narcotics, objects, and materials which might be used for homicidal or suicidal purposes inaccessible to patients. C. SECLUSION, RESTRAINT Patients shall not be placed in seclusion or in mechanical restraint except on written order of the physician in charge. D. SHOCK TREATMENT Shock treatment shall be given only by persons who are designated by the governing body or director as being adequately trained or instructed in such treatment. 21 V. Special Requirements for Turerculosis Hospitals A. DISPOSAL OF SPUTUM A rigid routine for daily collection of sputum cups and bedside paper bags shall be carried out. These shall be burned in an incinerator. B. CONTAGION TECHNIQUE An approved technique for preventing the spread of infection from pa- tient to employes shall be carried out. This applies particularly to the nurses giving bedside care, and masks and gowns shall be provided for their use. It is especially important that adequate hand-washing facilities be provided on all floors. All employes, professional and nonprofessional, shall be given pre-employment and annual examinations, including a chest X-ray. C. X-RAY DEPARTMENT The X-ray department should be located so as to be convenient to both in-patient and out-patient departments. A written report on each X-ray film taken shall be made and properly filed. D. DISHWASHING It is especially important that approved methods of washing and steril- izing dishes be enforced. E. REHABILITATION FACILITIES Larger sanitoria, generally 200 or more beds, should provide space for rehabilitation activities. This should include an auditorium for entertain- ment and religious worship, classrooms for instruction, and occupational therapy rooms. Larger sanitoria should also have a social service department headed by a qualified social service worker. VI. Hospital Standards Developed on a Point System EXPLANATORY The licensing agency, with approval of the Advisory Hospital Council, has adopted a point system to serve as a guide in measuring a hospital’s ability to meet requirements for licensure. The schedule of points on the following pages is intended to furnish a plan for taking an inventory of what the hospital has and what it does to promote the safety and comfort of patients and employes. No attempt is made to establish the relative importance of different phases of hospital care. An increase in bed capacity is usually accompanied by additional and im- proved facilities, broadening the field of activity, wider variety of services, and greater specialization in care of patients. Therefore, under a point system the number of points needed for Licensure will depend largely upon the size of the hospital. The table below shows the approximate number of points which general hospitals, according to size, are expected to attain. 4- 25 beds 400 points 26- 50 beds 500 points 51- 75 beds 600 points 76-100 beds 700 points 101-150 beds 800 points Over 150 beds 1,000 points Special Hospitals and Homes for Chronic or Convalescent Patients may rea- sonably be expected to meet the same standards as General Hospitals in facilities and services which are common to all; and correspondingly high standards in facilities and services peculiar to each. Important: A star (if) indicates a regulation which must be met or a standard which must be attained within a reasonable time (See Sec. 8 of Licensure Law) to continue operation of a hospital. SCHEDULE OF POINTS A. Accessibility Total points 10 1. Location convenient to doctors, employes and public 2 2. Parking facilities for staff and visitors 2 3. Sidewalks or paved approaches to entrances 2 4. Entrances and grounds adequately lighted 2 5. No unusual traffic hazards 2 B. Public Utilities Total points SO 1. Water supply 5 2. Sewerage system 5 3. Electric light and power 5 4. Public gas supply 5 5. Fire department 5 6. Telephone system 5 C. Environment Freedom from annoyance or danger from: Total points 10 1. Industrial plants, railroads, airports 3 2. Exposure to outside fire hazards 3 3. Adjacent fly or mosquito-breeding areas 2 4. Floods or poor surface drainage 1 5. Schools, playgrounds, athletic fields 1 D. Area Total points 6 1. Sufficiency for present needs 3 2. Room for expansion 3 E. Protected by zoning restrictions 4 Total Points for Part I, “Site” 60 I. SITE 23 11. GENERAL A. Safety and Sanitation 1. Housekeeping Total points 220 ★a. Interior surfaces clean and in good condition 5 ★b. Furniture, floor-coverings, equipment, clean and in good con- dition 5 c. Patients’ quarters comfortable and attractive 5 ★d. Effective measures for vermin and rodent control in use 5 e. Cleaning equipment adequate and adapted to hospital use. ... 5 2. Fire Prevention and Control—Safety Measures ★a. Meet requirements of state and local authorities 10 b. Building housing patients rated for insurance as fireproof or fire resistive 10 c. Automatic sprinkler system 10 d. Special care in handling or storing of combustible or explosive materials 5 3. Heating ★a. Adequate radiation 5 b. Central heating plant with thermostatic control 10 4. Water Supply ★a. From approved source 5 b. Hot and cold water outlets well distributed 5 5. Sewage Disposal ★a. Through approved sewerage system 5 (Additional if approved municipal system) 5 6. Plumbing ★a. Complies with state and local regulations, if any, and with re- quirements of State Board of Health 5 ★b. Adequate number of toilets, baths or showers, lavatories, sinks. . 5 7. Garbage Disposal ★a. Sanitary handling of garbage; infectious waste materials burned 5 b. Facilities for refrigeration of garbage 5 ★B. Screens for Outside Openings 5 9. Lighting ★a. Patients’ rooms have satisfactory natural light 5 ★b. Artificial lighting adequate in all parts of building, stairways, basement, etc 5 ★c. Wiring in good condition—safe installation of fixtures particu- larly in operating and delivery rooms 5 10. Emergency Lighting ★a. Battery operated lamps or flashlights—no open flame 5 Or emergency generator or battery system installed to supply circuits promptly with current 10 11. Ventilation ★a. All spaces for patients susceptible to frequent change of air- means of avoiding drafts in patients’ rooms 5 Or forced ventilation or air conditioning system 10 b. Exhaust fans in kitchen, laundries, and spaces lacking outlets. . 5 12. Stairways ★a. Handrails on all stairways; guardrails on open stairways 5 13. Elevators ★a. Installation comforming to recognized safety code and to state and local codes, if any—regular inspection 5 14. Laundry a. Adequate space, well ventilated, modern equipment, well op- erated-sufficient capacity 10 ★ Or good commercial laundry service 5 ★ 15. Incineration a. Equipped to burn infectious waste materials 5 16. Communication ★a. Telephone—private line 5 b. Intercommunicating system 5 17. Engineer a. Qualified full-time engineer 10 Or part time 5 b. Adequate work and storage space 5 c. Adequate and safe fuel storage 5 B. Dietary Total points 70 1. Supervised by graduate dietitian 15 ★ Or by competent person experienced in such work 5 2. Prepared daily menus on file 5 ★3. Kitchen area adequate—clean—good equipment—well ventilated... 5 ★4. Food storage—clean, well ventilated, affording complete protection against food contamination—refrigeration 5 ★5. Adequate dishwashing and disinfecting equipment and processes and means of garbage disposal 5 6. Sanitary glass-filling devices 5 ★7. Sanitary handling of ice used in food or drink 5 ★B. Use of only pasteurized, powdered or condensed milk 10 ★9. Adequate hand-washing facilities—common towel prohibited 5 10. Medical examination of all food handlers for pulmonary tuber- culosis 5 11. Ample dining area (12 square feet per person) 5 C. Accommodations for Patients Total points 70 ★l. All outside rooms—above ground level—communicating directly with corridor 5 2. Room areas (per bed—3 feet between beds) Private rooms 100 square feet, multiple-bed rooms 80 sq. ft 20 25 Private rooms 80 square feet, multiple-bed rooms 70 sq. ft 15 Private rooms 70 square feet, multiple-bed rooms 60 sq. ft 10 ★ No room area less than 60 square feet per bed 5 3. Window area adequate for natural light and ventilation 5 4. Room doors opening inward—sufficient width 5 ★5. Goods beds—plentiful supply of bedding and linen 5 6. Space for patients’ personal effects 5 ★7. Privacy for patients in multiple-bed rooms 5 ★B. Call signal convenient to each patient 5 ★9. Beds, bed furnishings, etc., thoroughly cleaned after discharge of patient 5 10. Rooms well equipped (adjustable bed, easy chair, floor lamp, lava- tory, etc.) and arranged for comfort and convenience of pa- tients 10 D. Nursing Department Total points 55 ★l. Ample space and facilities for cleaning and storage of equipment. . 5 2. Fixed stations for nurses 5 3. Nurses’ rest rooms—including toilets 5 ★4. Equipment—enamelware, hot-water bags, thermometers, etc 5 ★5. Drug and medicine cabinet 5 ★6. Locker for narcotics—record book 5 ★7. Sterilizing facilities—checks on performance 10 8. Lavatories, scrub-up sinks 5 ★9. Supply of individual towels, bath blankets, etc 5 ★ 10. Restraints—acceptable practice in use of 5 E. Hospital Records and Reports Total points 85 ★l. Medical records—meet substantially the recommendations of Ameri- can Medical Association or American College of Surgeons 40 ★2. Accounting system—complete record of income and disbursements, 5 Or conforming substantially to principles recommended by Ameri- can Hospital Association or other national organizations 15 3. Statistical information records 5 ★4. Birth certificates filed with local registrar 5 ★5. Birth and death lists sent promptly to Board of Health 5 ★6. Death certificates secured 5 ★7. Unclaimed bodies reported to University of Kansas Medical Center, 5 ★B. Burial permits obtained for bodies disposed of in hospital 5 ★F. Isolation of contagious disease patients or suspects 10 G. Laboratory Total points 40 ★l. Facilities and practices approved by Kansas Advisory Laboratory Commission 10 2. Autopsies performed on 15 per cent or more of annual deaths.... 10 3. Director—Certified by American Board of Pathology 10 4. Technicians certified by Board of Registry (American Society of Clinical Pathologists) . 10 H. X-ray Total points 40 1. Portable X-ray machine and fluoroscope 10 2. Complete X-ray diagnostic and/or therapeutic service under quali- fied roentgenologist 30 I. Personnel Total points 90 1. Employes Per Occupied Bed (Occupied bed equals patient days for 6 months divided by 183) 0.6 per occupied bed 3 0.7 per occupied bed 5 0.8 per occupied bed 10 0.9 per occupied bed 15 1.0 per occupied bed 20 1.1 per occupied bed 23 1.2 per occupied bed 25 2. Registered Nurses One registered nurse per 5 occupied beds 10 One registered nurse per 4 occupied beds 15 One registered nurse per 3 occupied beds 20 Registered nurse (surgical training) in charge of surgical depart- ment 10 Registered nurse (obstetrical training) in charge of obstetrical de- partment 10 All nursing service in charge of registered nurse 10 3. Practical Nurses Qualifications and duties defined as recommended by Kansas Nurses’ Association 5 4. Librarian (part-time if no more needed) 5 5. Librarian registered by American Association of Medical Record Librarians 5 J. Organization Total points 75 1. Governing body (Board or Individual) whose duties are defined by written instrument (Constitution and Bylaws) 5 2. Administrator or Executive Officer—competent and experienced- responsible to governing authority 10 3. Organized Medical Staff: Written bylaws, rules, and regulations; assuming responsiblity for all techniques involving professional care of patients; holding regular meetings; keeping records of proceedings 20 4. Approved by American College of Surgeons or registered by Ameri- can Medical Association; or approved or registered by other accredited national organization 10 5. Approved for Internships or Residencies by American College of Surgeons, American Medical Association, or by other accredited national organization 10 6. Approved school for nurses by Kansas Board of Examination and Registration for Nurses 10 27 7. Member of American Hospital Association or otner accredited national organization 5 8. Member of Kansas Hospital Association or other accredited state organization 5 111. MATERNITY SERVICE A. Nursing Total points 15 1. Nurse or nurses giving time exclusively to maternity patients—or employing isolation technique if serving other patients. . 10 2. Nurses examined and certified as free from communicable disease. . 5 B. Accommodations for Maternity Patients Total points 35 1. Maternity patients segregated 10 ★2. Isolation room or rooms 5 ★3. All nonbasement rooms; area 70 square feet or more per bed— larger area in multiple-bed rooms or wards; screens or curtains between beds in multiple-bed rooms or wards 5 4. Section of hospital equipped for and devoted exclusively to ma- ternity patients 10 5. Special labor rooms (1 per 10 obstetric beds) 5 C. Morbidity Standard Adopted 5 D. Delivery Total points 45 1. Rooms equipped and used exclusively for delivery (1 per 20 ob- stetric beds) segregated from other departments 20 ★2. Equipment for oxygen; transfusion; anesthesia; substerilizing 10 ★3. Incubator available 5 ★4. Reliable method of identification of infants 5 ★5. Surgical or spot light available 5 E. Provision for Infants Total points 50 1. Special nursery for infants (adequate area per bassinet) 20 ★2. Formula room or space for preparation of food 5 ★3. Isolation facilities and techniques for diseased or suspects 5 ★4. Heat, ventilation, and humidity regulation 5 5. Visiting restrictions 5 6. Special provisions for premature infants 5 7. Adequate work area . 5 MISCELLANEOUS A. Administration Total points 28 1. Business office and information desk 3 2. PBX board and night information desk 5 3. Medical record room 2 4. Staff lounge 2 5. Lobby 2 6. Public toilets 3 7. Administrator’s office 2 8. Director of nurses office 2 9. Admitting office 2 10. Library, conference or board room 5 B. Surgical Department Total points 50 1. Major operating room 5 2. Minor operating room 5 3. Cystoscopy room 5 4. Orthopedics room 5 5. Central sterilizing room 5 6. Instrument room 3 7. Anesthesia room and storage 5 8. Doctors’ lockers and showers 2 9. Station for supervisor 5 10. Air conditioned 5 11. Automatic temperature control 5 C. Emergency Department Total points 18 1. Accident room—near ambulance entrance 10 2. Accident room completely separated from surgical and obstetrical departments 3 3. Equipment and supplies adequate for anticipated use 5 D. Out-patient Department Total points 24 1. Easily accessible—on ground floor if possible 5 2. Convenient to X-ray, laboratory, etc 5 3. Waiting room and toilets available 3 4. Social service and screening room 5 5. Examining room 3 6. Dental unit 3 E. Special Bed Allocation 1. Beds devoted primarily to care of: Total points 40 a. Chronic diseases 10 b. Early tuberculosis 10 c. Early mental disorders 10 d. Contagious diseases 10 F. Employes Facilities Total points 30 1. For nurses (if no nurses home); locker rooms, showers, rest rooms, toilet in main building 10 Or nurses’ home 15 2. Nurses’ rest room and toilet on each floor 5 3. For other employes—available locker rooms, toilets, showers, rest rooms 10 G. Adjunct Diagnostic and Treatment Facilities Total points 60 1. Radiology—under direction of qualified radiologist 5 2. Physical Therapy—with qualified technician and adequate equip- ment 5 3. Anesthesia—organized department under direct supervision of a competent medical anesthetist 5 4. Electrocardiography—adequate equipment—supervised by physician trained in cardiology, competent technician 5 29 5. Oxygen Therapy—under supervision of member of medical staff with knowledge of apparatus and scientific principles of the therapy 10 6. Pharmacy—with registered pharmacist 10 7. Occupational Therapy—trained technician 5 8. Dental Department—a complete and self-contained unit organized on par with other departments 10 9. Cancer Clinic 5 H. Insurance Coverage: (1) Fire, lightning, tornado; (2) steam boiler; (3) workmen’s compensation; (4) public liability 5 VII. Hospital Licensure Law Chapter 329, Laws of Kansas, 1947 HOUSE BILL No. 67 An Act relating to hospitals; providing for the licensing, inspection and regu- lation thereof; creating a hospital advisory council and prescribing its powers and duties; authorizing the promulgation of rules and regulations and pro- viding enforcement procedures for carrying out the provisions of the act; and providing penalties for the violation thereof. Be it enacted by the Legislature of the State of Kansas: Section 1. Definitions. As used in this act: (a) “Hospital” means a place devoted primarily to the maintenance and operation of facilities for the diag- nosis, treatment or care for not less than twenty-four hours in any week of four or more nonrelated individuals suffering from illness, disease, injury, or de- formity, or a place devoted primarily to providing for not less than twenty-four hours in any week of obstetrical or other medical or nursing care for four or more nonrelated individuals. The term “hospital” shall include public health centers, but shall not include maternity homes or institutions primarily devoted to domiciliary care, such as boarding homes and homes for the aged or to homes or institutions which, as an exercise of religious freedom, are conducted in conformity with the practice of the religious tenets of any church in the ministration to the sick or suffering by spiritual means, and provided that quarantine regulations relating to contagious diseases are not infringed upon. (b) “Person” means any individual, firm, partnership, corporation, company, association, or joint stock association, and the legal successor thereof, (c) “Governmental unit” means the state, or any county, municipality, or other political subdivision thereof; or any department, division, board or other agency of any of the foregoing. (d) “Licensing agency” means the state board of health. Sec. 2. Purpose. The purpose of this act is to provide for the develop- ment, establishment and enforcement of standards: (1) For the care and treatment of individuals in hospitals; and (2) for the construction, maintenance and operation of hospitals, which, in the light of advancing knowledge, will promote safe and adequate treatment of such individuals in hospitals. Sec. 3. Licensure. After July 1, 1948, no person or governmental unit, acting severally or jointly with any other person or governmental unit shall establish, conduct or maintain a hospital in this state without a license under this law. Sec. 4. Application for license. An application for a license shall be made to the licensing agency upon forms provided by it and shall contain such in- formation as the licensing agency reasonably requires, which may include affirmative evidence of ability to comply with such reasonable standards, rules and regulations as are lawfully prescribed hereunder. Sec. 5. Issuance and renewal of license. Upon receipt of an application for license, the licensing agency shall issue a license provided the applicant and 31 the hospital facilities meet the requirements established under this act. A license, unless suspended or revoked, shall be renewable annually without charge upon the filing by the licensee, and approval by the licensing agency, of an annual report upon such uniform dates and containing such information in such fonn as the licensing agency prescribes by regulation. Each license shall be issued only for the premises and persons or governmental units named in the application and shall not be transferable or assignable except with the written approval of the licensing agency. Licenses shall be posted in a con- spicuous place on the licensed premises. Sec. 6. Denial or revocation of license; hearings and review. The licensing agency after notice and opportunity for hearing to the applicant or licensee is authorized to deny, suspend or revoke a license in any case in which it finds that there has been a substantial failure to comply with the requirements estab- lished under this law. Such notice shall be effected by registered mail, or by personal service setting forth the particular reasons for the proposed action and fixing a date not less than thirty days from the date of such mailing or service, at which the applicant or licensee shall be given an opportunity for a prompt and fair hearing. On the basis of any such hearing, or upon default of the applicant or licensee, the licensing agency shall make a determination specifying its findings of fact and conclusions of law. A copy of such determi- nation shall be sent by registered mail or served personally upon the applicant or licensee. The decision revoking, suspending or denying the license or appli- cation shall become final thirty days after it is so mailed or served, unless the applicant or licensee, within such thirty-day period, appeals the decision to the advisory council provided in section 10 of this act which shall convene within fifteen days after such appeal and may affirm, modify or reverse such decision or grant the licensee a period of time not exceeding one year in which the licensee shall make such changes as are necessary to comply with the require- ments established under this act, or may grant a conditional license to an appli- cant for a period not exceeding one year which conditional license shall auto- matically terminate on the date fixed unless the applicant shall, before such date, comply with the requirements established under this act. Any decision of the advisory hospital council revoking, suspending, or denying the license or application shall become final thirty days after it is mailed or served, unless the applicant or licensee appeals as provided in section 14 of this act. The procedure governing hearings authorized by this section shall be in accordance with rules promulgated by the licensing agency with the approval of the ad- visory hospital council. A full and complete record shall be kept of all pro- ceedings, and all testimony shall be reported but need not be transcribed unless the decision is appealed pursuant to section 14 hereof. A copy or copies of the transcript may be obtained by any interested party on payment of the cost of preparing such copy or copies. Witnesses may be subpoenaed by either party. Sec. 7. Rules, regulations, and enforcement. The licensing agency subject to the approval of the advisory hospital council, shall adopt, amend, promulgate and enforce such rules, regulations and standards with respect to all hospitals or different types of hospitals to be licensed hereunder as may be designed to further the accomplishment of the purposes of this law in promoting safe and adequate treatment of individuals in hospitals in the interest of public health, safety and welfare: Provided, That no rule or regulation shall be made by the licensing agency which would discriminate against any practitioner of the heal- ing art who is licensed to practice in this state: Provided further, That boards of trustees or directors of institutions licensed pursuant to the provisions of this act shall have the right to select the professional staff members of such institu- tions and to select and employ internes, nurses and other personnel and no rules, regulations or standards of the licensing agency shall be valid which, if enforced, would interfere in such selection or employment: And provided further. That in formulating rules and regulations, the agency shall give due consideration to the size of the hospital, the type of service it is intended to render, the scope of such service and the financial resources in and the needs of the community which such institution serves. Sec. 8. Effective date of regulations. Any hospital which is in operation at the time of promulgation of any applicable rules or regulations or minimum standards under this act shall be given a reasonable time, under the particular circumstances not to exceed two years from the date of such promulgation, within which to comply with such rules and regulations and minimum standards. Sec. 9. Inspections and considtations. The licensing agency shall make or cause to be made such inspections and investigations as it deems necessary. The licensing agency may prescribe by regulations that any licensee or appli- cant desiring to make specified types of alteration or additions to its facilities or to construct new facilities shall before commencing such alteration, addition or new construction, submit plans and specifications therefor to the licensing agency for preliminary inspection and approval or recommendations with respect to compliance with the regulations and standards herein authorized. Necessary conferences and consultations may be provided. Sec. 10. Advisory hospital council. The governor shall appoint an advisory hospital council to advise and consult with the licensing agency in carrying out the administration of this act. The council shall consist of nine members as follows: Three representatives of the Kansas hospital association; two members of the medical profession; one registered nurse who shall be a member of the Kansas state nurses’ association; and three persons representative of users of the hospital services, one of whom shall be the state chairman of the subscriber’s council of the Kansas hospital service association, inc. The secretary of the state board of health shall be ex officio secretary of such council. The council shall, annually, elect from its own membership a chairman. Each member shall hold office for a term of four years, except that any member appointed to fill a vacancy occurring prior to the expiration of the term for which his prede- cessor was appointed shall be appointed for the remainder of such term and the terms of office of the members first taking office shall expire, as designated at the time of the appointment, two at the end of the first year, two at the end of the second year, two at the end of the third year, and three at the end of the fourth year after the date of appointment. Council members while serving on the business of the council shall receive necessary travel and subsistence ex- penses while so serving away from their place of residence. The council shall meet as frequently as the chairman deems necessary, but not less than once each year. Upon request by three or more members, it shall be the duty of the chairman to call a meeting of the council. 33 Sec. 11. Functions of advisory hospital council. The advisory hospital council shall have the following responsibilities and duties: (a) To supervise and direct the licensing agency in matters of policy affecting administration of this act, and in the development and approval of rules, regulations and standards provided for hereunder. (b) To review on appeal of a licensee or applicant any order of the licensing agency revoking, denying or suspending a license and to affirm, modify or reverse such order. Sec. 12. Information confidential. Information received by the licensing agency through filed reports, inspections, or as otherwise authorized under this act, shall not be disclosed publicly in such manner as to identify individuals or hospitals, except in a proceeding involving the question of licensure. Sec. 13. Annual report of licensing agency. The licensing agency shall prepare and publish an annual report of its activities and operations under this law. Sec. 14. Judicial review. Any applicant or licensee aggrieved by the deci- sion of the advisory hospital council may, within thirty days after the mailing or serving of notice as provided in section 6 of this act, appeal to the district court of the county in which the hospital is located or is to be located. The district court shall try the appeal de novo and shall have the jurisdiction to affirm, modify, vacate or reverse the decision complained of. Notice of said appeal shall be filed in the office of the clerk of the district court and a copy thereof served upon the licensing agency within five days thereafter. Upon the filing of said appeal, the licensing agency shall, within twenty days, file with the clerk of the district court all records of the licensing agency and ad- visory hospital council in the case, including the evidence taken at the pro- ceedings. Either the applicant, licensee, licensing agent, or the state may apply for such further review as is provided by law in civil cases for appeals to the supreme court. Pending a final disposition of the matter, the status quo of the applicant or licensee shall be preserved except as the court otherwise orders in the public interest. Sec. 15. Penalties. Any person establishing, conducting, managing, or op- erating any hospital without a license under this law shall be guilty of a mis- demeanor, and upon conviction shall be fined not more than one hundred dollars for the first offense and not more than fifty dollars for each subsequent offense, and each day of a continuing violation after conviction shall be con- sidered a separate offense. Sec. 16. Injunction. Notwithstanding the existence or pursuit of any other remedy, the licensing agency may, in the manner provided by law, upon the advice of the attorney general who shall represent the licensing agency in the proceedings maintain an action in the name of the state for injunction or other process against any person or governmental unit to restrain or prevent the establishment, conduct, management or operation of a hospital without a license under this law. Sec. 17. Severability. If any provision of this act or the application thereof to any person or circumstance shall be held invalid, such invalidity shall not affect the provisions or application of this act which can be given effect without the invalid provision or application, and to this end the provisions of the act are declared to be severable. Sec. 18. This act shall take effect and be in force from and after its pub- lication in the statute book. Approved April 8, 1947. Published in Statute Book June 30, 1947. PRINTED BY FERD VO I LAN D. JR., STATE PRINTER TOPEKA, KANSAS 1948 22-3495