(a) A limited services rural hospital (LSRH) shall limit the surgical procedures performed at the LSRH to procedures the governing body approved upon the medical staff's recommendation.
(b) Adequate supervision of surgical procedures conducted in the LSRH shall be:
  (1) a responsibility of the governing body;
  (2) recommended by medical staff; and
  (3) provided by appropriate medical staff.
(c) An LSRH shall only perform surgical procedures when:
  (1) a physician, dentist, podiatrist, or other practitioner licensed to perform surgical procedures in Texas performs the procedure;
  (2) the governing body granted privileges to the physician, dentist, podiatrist, or other practitioner, practicing within the scope of their license and education, to perform surgical procedures;
  (3) the LSRH's medical staff recommended the surgical procedure; and
  (4) the governing body has medically reviewed the physician's, dentist's, podiatrist's, or other practitioner's documented education, training, experience, and current competence.
(d) An LSRH shall periodically review surgical procedures to be performed in the LSRH as part of the peer review portion of the LSRH's quality assessment and performance improvement program by physically observing planned surgical procedures.
(e) An LSRH shall incorporate an appropriate patient history, physical examination, and pertinent preoperative diagnostic studies into the patient's medical record before surgical procedures.
(f) Unless otherwise provided by law, the LSRH shall discuss the proposed surgical procedure's necessity or appropriateness, as well as any available alternative treatment techniques, with the patient or the patient's legally authorized representative, as applicable, before the surgical procedure.
(g) Unless otherwise provided by law, the LSRH shall obtain the informed consent of the patient or, if applicable, of the patient's legally authorized representative before a surgical procedure is performed. When the LSRH is unable to obtain informed consent before an emergency surgery, the LSRH shall document in the patient's medical record the reason or reasons why the LSRH was unable to obtain the informed consent.
(h) With the exception of those tissues exempted by the governing body after medical review, a pathologist shall examine tissues removed and sign or authenticate the report of the examination for the patient's medical record.
(i) A description of the findings and techniques of surgical procedures shall be accurately and completely incorporated into the patient's medical record immediately after the procedure by the physician or practitioner who performed the procedure. If the description is dictated, an accurate written summary shall be immediately available to the physicians and practitioners providing patient care and shall become a part of the patient's medical record.
(j) The LSRH shall allow patients who have received anesthesia, other than solely topical anesthesia, to leave the facility only in the company of a responsible adult, unless the physician, physician assistant, or an advanced practice registered nurse writes an order that the patient may leave without the company of a responsible adult.

Source Note: The provisions of this §511.52 adopted to be effective October 5, 2023, 48 TexReg 5668