Skip Navigation U.S. Department of Health and Human Services
Agency for Healthcare Research Quality
Archive print banner
Reopening Shuttered Hospitals to Expand Surge Capacity

Public Health Emergency Preparedness

This resource was part of AHRQ's Public Health Emergency Preparedness program, which was discontinued on June 30, 2011, in a realignment of Federal efforts.

This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: Let us know the nature of the problem, the Web address of what you want, and your contact information.

Please go to for current information.

Appendix D. Legal & Regulatory Issues (continued)

Chapter 5. Summary

The sections above detail current Federal and State regulatory requirements and issues that may need attention, if States decide to pursue the use of shuttered hospitals (or other settings such as churches, hotels, schools) for surge capacity expansion during a mass casualty event. In some cases clarification from Federal authorities is needed, in other mechanisms are needed to waive State regulations in emergency circumstances. 

Recommendation: Federal officials could create 'model' legislation and regulations for states to use as a starting point, to address surge facility issues.

The following table summarizes the most important Federal and State regulations, identifies those that may require waivers and those that probably do not.

Issue   Responsible Entity
Guidance/Waiver Likely Needed Federal Government State/Local Government>
Hospital Administration   X X
Compliance with Federal, State and Local Laws   X X
Governing Body X X X
Quality Assessment and Performance Improvement Program X X  
Services   X X
Pharmaceutical Services   X X
Radiologic Services   X X
Laboratory Services X X X
Food and Dietetic Services   X X
Utilization Review X X X
Physical Environment   X X
Infection Control   X X
Discharge Planning X X X
Organ, Tissue, and Eye Procurement X X  
Surgical Services N/A    
Anesthesia Services N/A    
Nuclear Medicine N/A    
Outpatient Services N/A    
Rehabilitation Services N/A    
Respiratory Care Services N/A    
Staffing   X X
Medical staff   X X
Nursing services   X X
Medical records X X X
Pharmaceutical services X X X
Radiologic services   X X
Laboratory services X X X
Food and Dietetic services   X X
Long-term Care Staffing   X  
Nursing   X  
Dietary   X  
Social services   X  
Patient Rights   X X
Notice of rights   X X
Exercise of rights   X X
Confidentiality of patient records   X X
Restraint for acute medical and surgical care   X  
Seclusion and restraint for behavior mgt   X  
Patient Information and Privacy Standards   X X
Organization and staffing   X X
Form and retention of records X X X
Health information privacy X X  
Other Issues   X X
Status of a new hospital X   X
Determination of need X   X
Construction plan approval for renovations X   X
Public safety and fire certificates X   X
Obtaining a license X   X
Medical personnel credentialing X   X
Complaints and incident reports     X
Sharps and disposal of medical waste     X
Reportable diseases, isolation, and quarantine     X
Authority to open a surge facility X   X
Operation and control of a surge facility X   X
Liability X X X
Medical personnel—crossing State lines X   X
Physician back-up by other health-care providers   X X

Return to Appendix D Contents
Proceed to Next Section


The information on this page is archived and provided for reference purposes only.


AHRQ Advancing Excellence in Health Care