On July 21, 2020, the Office of Civil Rights (OCR) announced settlement of a patient complaint with the Prince George’s Hospital Center of the University of Maryland Medical System (UMMS) that enforces a patient’s right to religious visitation in health care facilities even during the COVID-19 pandemic.

The patient was in an intensive care unit following a major car accident. His family requested that a local priest visit and pray with the patient. UMMS denied visitation even though the priest was willing to wear any necessary personal protective equipment and adhere to UMMS infection control and visitor procedures. The Centers for Medicare and Medicaid Services (CMS) through the OCR provided technical assistance to UMMS and required revision to visitor policies for all 13 hospitals in the UMMS system. Of note, the OCR did not impose any penalties or other sanctions. However, as federal guidance becomes better known, enforcement other than technical assistance could become more common.

The OCR announcement and the UMMS policy provide insight into what is prohibited and permissible in visitor policies during the pandemic or any infection control situation. The settlement builds on the CMS revised Infection Control and Prevention Guidance issued on March 30, 2020.

Prohibited:

• Blanket prohibition on visitors for patients without COVID-19.
• Total prohibition on visitors for patients diagnosed with COVID-19 or who are under investigation for exposure to COVID-19.
• Blanket prohibition or restrictions on religious services from clergy for patients who are not suspected or confirmed to have COVID-19 other than limiting such visits and services to a reasonable time in a manner that does not disrupt care.

Limited Exceptions:

Visitation, including by clergy, of patients with COVID-19 or who are under investigation for contracting COVID-19 can be restricted to limited exceptions:

• At the end of life.
• For end of life religious services.
• Two parents or guardians may visit a child during hospital visiting hours and one may remain overnight if the hospital can accommodate the overnight visit.
• Patients with disabilities, including those who are suspected or confirmed to have COVID-19, may have two designated support persons or guardians stay with them during hospital visiting hours and one may remain overnight if the hospital can accommodate him or her.

Permitted:

• Screening visitors for COVID-19 or exposure to COVID-19.
• Limiting the number of visitors and hours for visitation.
• Restricting the location for visitation.
• Requiring personal protective equipment, such as facemasks.
• Prohibiting visitation during active clinical care.
• Prohibiting visitation for patients with suspected or confirmed COVID-19 except in the circumstances listed above.
• Prohibiting visitation for outpatients with suspected or confirmed COVID-19 except for persons with disabilities.
• Limiting visitors for outpatient appointments to designated waiting areas except for patients with disabilities in need of support persons.
• Limiting visitors to age 18 or older unless they are the parent of a patient.
• Limiting visitors to one person per day.
• Not permitting visitors to leave and come back in the same day.
• Enforcement of proper infection prevention practices and adherence to visitor policy rules.
• Requiring visitors to sign an acknowledgment or acceptance of risk, particularly in visiting COVID positive units.

Facilities should review visitor policies to ensure they adhere to this guidance. Facilities would also be well served to develop criteria for evaluating what constitutes “end of life“ and who qualifies as a “person with disabilities in need of a support person.”

Having such guidance in place will inform patients, reduce arbitrariness or inconsistency in applying the policy to different religious denominations, forms of disability and patient circumstances, help staff enforce appropriate policies and reduce the risk of violating patient rights and OCR guidance. OCR is likely to become less tolerant of inappropriate visitor policies now that CMS has provided guidance and OCR has announced enforcement that implements CMS guidance.