1-1 By: Harris of Tarrant, Moncrief, Zaffirini S.B. No. 207
1-2 (In the Senate - Filed January 29, 1993; February 1, 1993,
1-3 read first time and referred to Committee on Health and Human
1-4 Services; March 19, 1993, reported adversely, with favorable
1-5 Committee Substitute by the following vote: Yeas 7, Nays 0;
1-6 March 19, 1993, sent to printer.)
1-7 COMMITTEE VOTE
1-8 Yea Nay PNV Absent
1-9 Zaffirini x
1-10 Ellis x
1-11 Madla x
1-12 Moncrief x
1-13 Nelson x
1-14 Patterson x
1-15 Shelley x
1-16 Truan x
1-17 Wentworth x
1-18 COMMITTEE SUBSTITUTE FOR S.B. No. 207 By: Moncrief
1-19 A BILL TO BE ENTITLED
1-20 AN ACT
1-21 relating to the regulation of the provision of mental health and
1-22 chemical dependency services and of billing for health services.
1-23 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-24 ARTICLE 1
1-25 SECTION 1.01. Chapter 571, Health and Safety Code, is
1-26 amended by adding Section 571.0065 to read as follows:
1-27 Sec. 571.0065. PRESCRIPTION MEDICATION INFORMATION.
1-28 (a) The board by rule shall require a mental health facility that
1-29 admits a patient under this subtitle to provide to the patient in
1-30 the patient's primary language, if possible, information relating
1-31 to prescription medications ordered by the patient's treating
1-32 physician.
1-33 (b) At a minimum, the required information must:
1-34 (1) identify the major types of prescription
1-35 medications; and
1-36 (2) specify for each major type:
1-37 (A) the conditions the medications are commonly
1-38 used to treat;
1-39 (B) the beneficial effects on those conditions
1-40 generally expected from the medications;
1-41 (C) side effects and risks associated with the
1-42 medications;
1-43 (D) commonly used examples of medications of the
1-44 major type; and
1-45 (E) sources of detailed information concerning a
1-46 particular medication.
1-47 (c) The facility shall also provide the information to the
1-48 patient's family on request, but only to the extent not otherwise
1-49 prohibited by state or federal confidentiality laws.
1-50 SECTION 1.02. Subsection (b), Section 572.003, Health and
1-51 Safety Code, is amended to read as follows:
1-52 (b) In addition to the rights provided by this subtitle
1-53 <Sections 572.004, 576.001, 576.006, 576.007, 576.008, 576.009, and
1-54 576.021>, a person voluntarily admitted to an inpatient mental
1-55 health facility under this chapter has the right:
1-56 (1) to be reviewed periodically to determine the
1-57 person's need for continued inpatient treatment; and
1-58 (2) to have an application for court-ordered mental
1-59 health services filed only as provided by Section 572.005.
1-60 SECTION 1.03. (a) Chapter 572, Health and Safety Code, is
1-61 amended by adding Section 572.0022 to read as follows:
1-62 Sec. 572.0022. INFORMATION ON MEDICATIONS. (a) A mental
1-63 health facility shall provide to a patient in the patient's primary
1-64 language, if possible, and in accordance with rules adopted under
1-65 Section 571.0065 information relating to prescription medication
1-66 ordered by the patient's treating physician.
1-67 (b) The facility shall also provide the information to the
1-68 patient's family on request, but only to the extent not otherwise
2-1 prohibited by state or federal confidentiality laws.
2-2 (b) This section takes effect May 1, 1994.
2-3 SECTION 1.04. Section 572.005, Health and Safety Code, is
2-4 amended to read as follows:
2-5 Sec. 572.005. APPLICATION FOR COURT-ORDERED TREATMENT.
2-6 (a) An application for court-ordered mental health services may
2-7 not be filed against a patient receiving voluntary inpatient
2-8 services unless:
2-9 (1) a request for release of the patient has been
2-10 filed with the facility administrator; or
2-11 (2) in the <facility administrator's> opinion of the
2-12 physician responsible for the patient's treatment, the patient
2-13 meets the criteria for court-ordered mental health services and:
2-14 (A) is absent from the facility without
2-15 authorization; <or>
2-16 (B) <refuses or> is unable to consent to
2-17 appropriate and necessary psychiatric treatment; or
2-18 (C) refuses to consent to necessary and
2-19 appropriate treatment recommended by the physician responsible for
2-20 the patient's treatment and that physician completes a certificate
2-21 of medical examination for mental illness that, in addition to the
2-22 information required by Section 574.011, includes the opinion of
2-23 the physician that:
2-24 (i) there is no reasonable alternative to
2-25 the treatment recommended by the physician; and
2-26 (ii) the patient will not benefit from
2-27 continued inpatient care without the recommended treatment.
2-28 (b) The physician responsible for the patient's treatment
2-29 shall notify the patient if the physician intends to file an
2-30 application for court-ordered mental health services.
2-31 SECTION 1.05. (a) Subchapter D, Chapter 574, Health and
2-32 Safety Code, is amended by adding Section 574.0415 to read as
2-33 follows:
2-34 Sec. 574.0415. INFORMATION ON MEDICATIONS. (a) A mental
2-35 health facility shall provide to a patient in the patient's primary
2-36 language, if possible, and in accordance with rules adopted under
2-37 Section 571.0065 information relating to prescription medication
2-38 ordered by the patient's treating physician.
2-39 (b) The facility shall also provide the information to the
2-40 patient's family on request, but only to the extent not otherwise
2-41 prohibited by state or federal confidentiality laws.
2-42 (b) This section takes effect May 1, 1994.
2-43 SECTION 1.06. Section 576.006, Health and Safety Code, is
2-44 amended to read as follows:
2-45 Sec. 576.006. RIGHTS SUBJECT TO LIMITATION <BY FACILITY
2-46 ADMINISTRATOR>. (a) A patient in an inpatient mental health
2-47 facility has the right to:
2-48 (1) receive visitors;
2-49 (2) communicate with a person outside the facility by
2-50 telephone and by uncensored and sealed mail; and
2-51 (3) communicate by telephone and by uncensored and
2-52 sealed mail with legal counsel, the department, the courts, and the
2-53 state attorney general.
2-54 (b) The rights provided in Subsection (a) are subject to the
2-55 general rules of the facility. The physician ultimately
2-56 responsible for the patient's treatment <facility administrator>
2-57 may also restrict a right only to the extent <the facility
2-58 administrator determines> that the restriction is necessary to the
2-59 patient's welfare or to protect another person but may not restrict
2-60 the right to communicate with legal counsel, the department, the
2-61 courts, or the state attorney general <if an attorney-client
2-62 relationship has been established>.
2-63 (c) If a <A> restriction is imposed under this section, the
2-64 physician ultimately responsible for the patient's treatment shall
2-65 document the clinical <by the facility administrator for the
2-66 patient's welfare and the> reasons for the restriction and the
2-67 duration of the restriction in <shall be made a part of> the
2-68 patient's clinical record. That physician shall inform the patient
2-69 and, if appropriate, the patient's parent, managing conservator, or
2-70 guardian of the clinical reasons for the restriction and the
3-1 duration of the restriction.
3-2 SECTION 1.07. Section 576.009, Health and Safety Code, is
3-3 amended to read as follows:
3-4 Sec. 576.009. NOTIFICATION OF RIGHTS. A patient receiving
3-5 involuntary inpatient mental health services shall be informed of
3-6 the rights provided by this subtitle <in Sections 576.001, 576.006,
3-7 576.007, 576.008, and 576.021>:
3-8 (1) orally, in simple, nontechnical terms, and in
3-9 writing that, if possible, is in the person's primary language; or
3-10 (2) through the use of a means reasonably calculated
3-11 to communicate with a hearing impaired or visually impaired person,
3-12 if applicable.
3-13 SECTION 1.08. Chapter 574, Health and Safety Code, is
3-14 amended by adding Subchapter G to read as follows:
3-15 SUBCHAPTER G. ADMINISTRATION OF MEDICATION
3-16 TO PATIENT UNDER ORDER FOR INPATIENT MENTAL HEALTH SERVICES
3-17 Sec. 574.101. DEFINITIONS. In this subchapter:
3-18 (1) "Capacity" means a patient's ability to:
3-19 (A) understand the nature and consequences of a
3-20 proposed treatment, including the benefits, risks, and alternatives
3-21 to the proposed treatment; and
3-22 (B) make a decision whether to undergo the
3-23 proposed treatment.
3-24 (2) "Medication-related emergency" means a situation
3-25 in which it is immediately necessary to administer medication to a
3-26 patient to prevent:
3-27 (A) imminent probable death or substantial
3-28 bodily harm to the patient because the patient:
3-29 (i) overtly or continually is threatening
3-30 or attempting to commit suicide or serious bodily harm; or
3-31 (ii) is behaving in a manner that
3-32 indicates that the patient is unable to satisfy the patient's need
3-33 for nourishment, essential medical care, or self-protection; or
3-34 (B) imminent physical or emotional harm to
3-35 another because of threats, attempts, or other acts the patient
3-36 overtly or continually makes or commits.
3-37 (3) "Psychoactive medication" means a medication
3-38 prescribed for the treatment of symptoms of psychosis or other
3-39 severe mental or emotional disorders and that is used to exercise
3-40 an effect on the central nervous system to influence and modify
3-41 behavior, cognition, or affective state when treating the symptoms
3-42 of mental illness. "Psychoactive medication" includes the
3-43 following categories when used as described in this subdivision:
3-44 (A) antipsychotics or neuroleptics;
3-45 (B) antidepressants;
3-46 (C) agents for control of mania or depression;
3-47 (D) antianxiety agents;
3-48 (E) sedatives, hypnotics, or other
3-49 sleep-promoting drugs; and
3-50 (F) psychomotor stimulants.
3-51 Sec. 574.102. APPLICATION OF SUBCHAPTER. This subchapter
3-52 applies only to the application of medication to a patient subject
3-53 to an order for inpatient mental health services under Section
3-54 574.034 or 574.035 who is receiving those services in a mental
3-55 health facility operated or funded by the department.
3-56 Sec. 574.103. ADMINISTRATION OF MEDICATION TO PATIENT UNDER
3-57 COURT-ORDERED MENTAL HEALTH SERVICES. A person may not administer
3-58 a psychoactive medication to a patient who refuses to take the
3-59 medication voluntarily unless:
3-60 (1) the patient is having a medication-related
3-61 emergency; or
3-62 (2) the patient is under an order issued under Section
3-63 574.106 authorizing the administration of the medication regardless
3-64 of the patient's refusal.
3-65 Sec. 574.104. PHYSICIAN'S PETITION FOR ORDER TO COMPEL
3-66 PSYCHOACTIVE MEDICATION; DATE OF HEARING. (a) A physician who is
3-67 treating a patient may petition a probate court or a court with
3-68 probate jurisdiction for an order to authorize the administration
3-69 of a psychoactive medication regardless of the patient's refusal
3-70 if:
4-1 (1) the physician believes that the patient lacks the
4-2 capacity to make a decision regarding the administration of the
4-3 psychoactive medication;
4-4 (2) the physician determines that the medication is
4-5 the proper course of treatment for the patient; and
4-6 (3) the patient is under an order for temporary or
4-7 extended mental health services under Section 574.034 or 574.035
4-8 and the patient, verbally or by other indication, refuses to take
4-9 the medication voluntarily.
4-10 (b) A petition filed under this section must state:
4-11 (1) that the physician believes that the patient lacks
4-12 the capacity to make a decision regarding administration of the
4-13 psychoactive medication and the reasons for that belief;
4-14 (2) each medication the physician wants the court to
4-15 compel the patient to take;
4-16 (3) whether the current order for inpatient mental
4-17 health services for the patient was issued under Section 574.034 or
4-18 under Section 574.035; and
4-19 (4) the physician's diagnosis of the patient.
4-20 (c) A petition filed under this section is separate from an
4-21 application for court-ordered mental health services.
4-22 (d) The court with which a petition is filed under this
4-23 section shall set a hearing on the petition to be held not later
4-24 than the seventh day after the date the petition is filed. The
4-25 hearing on the petition may be held on the date of a hearing on an
4-26 application for court-ordered extended mental health services under
4-27 Section 574.035. The hearing on the petition may not be held on
4-28 the date of a hearing on an application for court-ordered temporary
4-29 mental health services under Section 574.034 unless the patient and
4-30 the patient's attorney agree in writing to have the hearing on that
4-31 date.
4-32 (e) The court may grant one continuance on a party's motion
4-33 and for good cause shown. The court may grant more than one
4-34 continuance only with the agreement of the parties.
4-35 Sec. 574.105. RIGHTS OF PATIENT. A patient for whom a
4-36 petition for an order to authorize the administration of a
4-37 psychoactive medication is filed is entitled to:
4-38 (1) representation by a court-appointed attorney who
4-39 is knowledgeable about issues to be adjudicated at the hearing;
4-40 (2) meet with that attorney as soon as is practicable
4-41 to prepare for the hearing and to discuss any of the patient's
4-42 questions or concerns;
4-43 (3) receive, immediately after the time of the hearing
4-44 is set, a copy of the petition and written notice of the time,
4-45 place, and date of the hearing;
4-46 (4) be told, at the time personal notice of the
4-47 hearing is given, of the patient's right to a hearing and right to
4-48 the assistance of an attorney to prepare for the hearing and to
4-49 answer any questions or concerns;
4-50 (5) be present at the hearing;
4-51 (6) request from the court an independent expert; and
4-52 (7) oral notification, at the conclusion of the
4-53 hearing, of the court's determinations of the patient's capacity
4-54 and best interests.
4-55 Sec. 574.106. HEARING ON PATIENT'S CAPACITY AND ORDER
4-56 AUTHORIZING PSYCHOACTIVE MEDICATION. (a) The court may issue an
4-57 order authorizing the administration of one or more classes of
4-58 psychoactive medication only if the court finds by clear and
4-59 convincing evidence after the hearing that:
4-60 (1) the patient lacks the capacity to make a decision
4-61 regarding the administration of the proposed medication; and
4-62 (2) treatment with the proposed medication is in the
4-63 best interest of the patient.
4-64 (b) In making its findings, the court shall consider:
4-65 (1) the patient's expressed preferences regarding
4-66 treatment with psychoactive medication;
4-67 (2) the patient's religious beliefs;
4-68 (3) the risks and benefits, from the perspective of
4-69 the patient, of taking psychoactive medication;
4-70 (4) the consequences to the patient if the
5-1 psychoactive medication is not administered;
5-2 (5) the prognosis for the patient if the patient is
5-3 treated with psychoactive medication; and
5-4 (6) alternatives to treatment with psychoactive
5-5 medication.
5-6 (c) A hearing under this subchapter shall be conducted by
5-7 the probate judge or judge with probate jurisdiction, except as
5-8 provided by Subsection (d).
5-9 (d) A judge may refer a hearing to a magistrate or
5-10 court-appointed master who has training regarding psychoactive
5-11 medications.
5-12 (e) A party is entitled to a hearing by the judge if an
5-13 appeal of the magistrate's or master's report is filed with the
5-14 court within three days after the report is issued.
5-15 (f) If a hearing or an appeal of a master's or magistrate's
5-16 report is to be held in a county court in which the judge is not a
5-17 licensed attorney, the proposed patient or the proposed patient's
5-18 attorney may request that the proceeding be transferred to a court
5-19 with a judge who is licensed to practice law in this state. The
5-20 county judge shall transfer the case after receiving the request,
5-21 and the receiving court shall hear the case as if it had been
5-22 originally filed in that court.
5-23 (g) As soon as practicable after the conclusion of the
5-24 hearing, the patient is entitled to have provided to the patient
5-25 and the patient's attorney written notification of the court's
5-26 determinations under this section. The notification shall include
5-27 a statement of the evidence on which the court relied and the
5-28 reasons for the court's determinations.
5-29 (h) An order entered under this section shall authorize the
5-30 administration to a patient, regardless of the patient's refusal,
5-31 of one or more classes of psychoactive medications specified in the
5-32 petition and consistent with the patient's diagnosis. The order
5-33 shall permit an increase or decrease in a medication's dosage,
5-34 restitution of medication authorized but discontinued during the
5-35 period the order is valid, or the substitution of a medication
5-36 within the same class.
5-37 (i) The classes of psychoactive medications in the order
5-38 must conform to classes determined by the department.
5-39 (j) An order issued under this section may be reauthorized
5-40 or modified on the petition of a party. The order remains in
5-41 effect pending action on a petition for reauthorization or
5-42 modification. For the purpose of this subsection, "modification"
5-43 means a change of a class of medication authorized in the order.
5-44 Sec. 574.107. APPEAL. (a) A patient may appeal an order
5-45 under this subchapter in the manner provided by Section 574.070 for
5-46 an appeal of an order requiring court-ordered mental health
5-47 services.
5-48 (b) An order authorizing the administration of medication
5-49 regardless of the refusal of the patient is effective pending an
5-50 appeal of the order.
5-51 Sec. 574.108. EFFECT OF ORDER. (a) A person's consent to
5-52 take a psychoactive medication is not valid and may not be relied
5-53 on if the person is subject to an order issued under Section
5-54 574.106.
5-55 (b) The issuance of an order under Section 574.106 is not a
5-56 determination or adjudication of mental incompetency and does not
5-57 limit in any other respect that person's rights as a citizen or the
5-58 person's property rights or legal capacity.
5-59 Sec. 574.109. EXPIRATION AND REVIEW OF ORDER. (a) The
5-60 court annually shall review an order issued under Section 574.106.
5-61 (b) An order issued under Section 574.106 expires on the
5-62 expiration or termination date of the order for temporary or
5-63 extended mental health services in effect when the order for
5-64 psychoactive medication is issued.
5-65 SECTION 1.09. Subchapter B, Chapter 576, Health and Safety
5-66 Code, is amended by adding Sections 576.025 and 576.026 to read as
5-67 follows:
5-68 Sec. 576.025. ADMINISTRATION OF PSYCHOACTIVE MEDICATION.
5-69 (a) A person may not administer a psychoactive medication to a
5-70 patient receiving voluntary or involuntary mental health services
6-1 who does not consent to the administration unless:
6-2 (1) the patient is having a medication-related
6-3 emergency;
6-4 (2) the patient is younger than 16 years of age and
6-5 the patient's parent, managing conservator, or guardian consents to
6-6 the administration on behalf of the patient;
6-7 (3) the patient does not have the capacity to consent
6-8 and the patient's representative authorized by law to consent on
6-9 behalf of the patient has consented to the administration; or
6-10 (4) the administration of the medication regardless of
6-11 the patient's refusal is authorized by an order issued under
6-12 Section 574.106.
6-13 (b) Consent to the administration of psychoactive medication
6-14 given by a patient or by a person authorized by law to consent on
6-15 behalf of the patient is valid only if:
6-16 (1) the consent is given voluntarily and without
6-17 coercive or undue influence;
6-18 (2) the treating physician or a person designated by
6-19 the physician provided the following information, in a standard
6-20 format approved by the department, to the patient and, if
6-21 applicable, to the patient's representative authorized by law to
6-22 consent on behalf of the patient:
6-23 (A) the specific condition to be treated;
6-24 (B) the beneficial effects on that condition
6-25 expected from the medication;
6-26 (C) the probable health and mental health
6-27 consequences of not consenting to the medication;
6-28 (D) the probable clinically significant side
6-29 effects and risks associated with the medication;
6-30 (E) the generally accepted alternatives to the
6-31 medication, if any, and why the physician recommends that they be
6-32 rejected; and
6-33 (F) the proposed course of the medication;
6-34 (3) the patient and, if appropriate, the patient's
6-35 representative authorized by law to consent on behalf of the
6-36 patient is informed in writing that consent may be revoked; and
6-37 (4) the consent is evidenced in the patient's clinical
6-38 record by a signed form prescribed by the facility or by a
6-39 statement of the treating physician or a person designated by the
6-40 physician that documents that consent was given by the appropriate
6-41 person and the circumstances under which the consent was obtained.
6-42 (c) If the treating physician designates another person to
6-43 provide the information under Subsection (b), then, not later than
6-44 two working days after that person provides the information,
6-45 excluding weekends and legal holidays, the physician shall meet
6-46 with the patient and, if appropriate, the patient's representative
6-47 who provided the consent, to review the information and answer any
6-48 questions.
6-49 (d) A patient's refusal or attempt to refuse to receive
6-50 psychoactive medication, whether given verbally or by other
6-51 indications or means, shall be documented in the patient's clinical
6-52 record.
6-53 (e) In prescribing psychoactive medication, a treating
6-54 physician shall:
6-55 (1) prescribe, consistent with clinically appropriate
6-56 medical care, the medication that has the fewest side effects or
6-57 the least potential for adverse side effects, unless the class of
6-58 medication has been demonstrated or justified not to be effective
6-59 clinically; and
6-60 (2) administer the smallest therapeutically acceptable
6-61 dosages of medication for the patient's condition.
6-62 (f) If a physician issues an order to administer
6-63 psychoactive medication to a patient without the patient's consent
6-64 because the patient is having a medication-related emergency:
6-65 (1) the physician shall document in the patient's
6-66 clinical record in specific medical or behavioral terms the
6-67 necessity of the order and that the physician has evaluated but
6-68 rejected other generally accepted, less intrusive forms of
6-69 treatment, if any; and
6-70 (2) treatment of the patient with the psychoactive
7-1 medication shall be provided in the manner, consistent with
7-2 clinically appropriate medical care, least restrictive of the
7-3 patient's personal liberty.
7-4 (g) In this section, "medication-related emergency" and
7-5 "psychoactive medication" have the meanings assigned by Section
7-6 574.101.
7-7 Sec. 576.026. INDEPENDENT EVALUATION. (a) A patient
7-8 receiving inpatient mental health services under this subtitle is
7-9 entitled to obtain at the patient's cost an independent
7-10 psychiatric, psychological, or medical examination or evaluation by
7-11 a psychiatrist, physician, or nonphysician mental health
7-12 professional chosen by the patient. The facility administrator
7-13 shall allow the patient to obtain the examination or evaluation at
7-14 any reasonable time.
7-15 (b) If the patient is a minor, the minor and the minor's
7-16 parent, legal guardian, or managing or possessory conservator is
7-17 entitled to obtain the examination or evaluation. The cost of the
7-18 examination or evaluation shall be billed by the professional who
7-19 performed the examination or evaluation to the person responsible
7-20 for payment of the minor's treatment as a cost of treatment.
7-21 SECTION 1.10. Subchapter B, Chapter 576, Health and Safety
7-22 Code, is amended by adding Section 576.027 to read as follows:
7-23 Sec. 576.027. LIST OF MEDICATIONS. (a) The facility
7-24 administrator of an inpatient mental health facility shall provide
7-25 to a patient, a person designated by the patient, and the patient's
7-26 legal guardian or managing conservator, if any, a list of the
7-27 medications prescribed for administration to the patient while the
7-28 patient is in the facility. The list must include for each
7-29 medication:
7-30 (1) the name of the medication;
7-31 (2) the dosage and schedule prescribed for the
7-32 administration of the medication; and
7-33 (3) the name of the physician who prescribed the
7-34 medication.
7-35 (b) The list must be provided within four hours after the
7-36 facility administrator receives a written request for the list from
7-37 the patient, a person designated by the patient, or the patient's
7-38 legal guardian or managing conservator and on the discharge of the
7-39 patient. If sufficient time to prepare the list before discharge
7-40 is not available, the list may be mailed within 24 hours after
7-41 discharge to the patient, a person designated by the patient, and
7-42 the patient's legal guardian or managing conservator.
7-43 (c) A patient or the patient's legal guardian or managing
7-44 conservator, if any, may waive the right of any person to receive
7-45 the list of medications while the patient is participating in a
7-46 research project if release of the list would jeopardize the
7-47 results of the project.
7-48 SECTION 1.11. Subsection (b), Section 611.002, Health and
7-49 Safety Code, is amended to read as follows:
7-50 (b) Confidential communications or records may not be
7-51 disclosed except as provided by Section 611.004 or 611.0045.
7-52 SECTION 1.12. Chapter 611, Health and Safety Code, is
7-53 amended by adding Section 611.0045 to read as follows:
7-54 Sec. 611.0045. RIGHT TO MENTAL HEALTH RECORD. (a) Except
7-55 as otherwise provided by this section, a patient is entitled to
7-56 have access to the content of a confidential record made about the
7-57 patient.
7-58 (b) The professional may deny access to any portion of a
7-59 record if the professional determines that release of that portion
7-60 would be harmful to the patient's physical, mental, or emotional
7-61 health.
7-62 (c) If the professional denies access to any portion of a
7-63 record, the professional shall give the patient a signed and dated
7-64 written statement that having access to the record would be harmful
7-65 to the patient's physical, mental, or emotional health and shall
7-66 include a copy of the written statement in the patient's records.
7-67 The statement must specify the portion of the record to which
7-68 access is denied, the reason for denial, and the duration of the
7-69 denial.
7-70 (d) The professional who denies access to a portion of a
8-1 record under this section shall redetermine the necessity for the
8-2 denial at least quarterly and at each time a request for the denied
8-3 portion is made. If the professional again denies access, the
8-4 professional shall notify the patient of the denial and document
8-5 the denial as prescribed by Subsection (c).
8-6 (e) If a professional denies access to a portion of a
8-7 confidential record, the professional shall allow examination and
8-8 copying of the record by another professional if the patient
8-9 selects the professional to treat the patient for the same or a
8-10 related condition as the professional denying access.
8-11 (f) The content of a confidential record shall be made
8-12 available to a person listed by Section 611.004(a)(4) or (5) who is
8-13 acting on the patient's behalf.
8-14 (g) A professional shall delete confidential information
8-15 about another person who has not consented to the release, but may
8-16 not delete information relating to the patient that another person
8-17 has provided, the identity of the person responsible for that
8-18 information, or the identity of any person who provided information
8-19 that resulted in the patient's commitment, admission, or treatment.
8-20 (h) If a summary or narrative of a confidential record is
8-21 requested by the patient or other person requesting release under
8-22 this section, the professional shall prepare the summary or
8-23 narrative.
8-24 (i) The professional or other entity that has possession or
8-25 control of the record shall grant access to any portion of the
8-26 record to which access is not specifically denied under this
8-27 section within a reasonable time and may charge a reasonable fee.
8-28 (j) Notwithstanding Section 5.08, Medical Practice Act
8-29 (Article 4495b, Vernon's Texas Civil Statutes), this section
8-30 applies to the release of a confidential record created or
8-31 maintained by a professional, including a physician, that relates
8-32 to the diagnosis, evaluation, or treatment of a mental or emotional
8-33 condition or disorder, including alcoholism or drug addiction.
8-34 (k) The denial of a patient's access to any portion of a
8-35 record by the professional or other entity that has possession or
8-36 control of the record suspends, until the release of that portion
8-37 of the record, the running of an applicable statute of limitations
8-38 on a cause of action in which evidence relevant to the cause of
8-39 action is in that portion of the record.
8-40 SECTION 1.13. Section 611.005, Health and Safety Code, is
8-41 amended to read as follows:
8-42 Sec. 611.005. LEGAL REMEDIES FOR IMPROPER DISCLOSURE OR
8-43 FAILURE TO DISCLOSE. (a) A person aggrieved by the improper
8-44 disclosure of or failure to disclose confidential communications or
8-45 records in <a> violation of this chapter may petition the district
8-46 court of the county in which the person resides for appropriate
8-47 <injunctive> relief, including injunctive relief. The person may
8-48 petition a district court of Travis County if the person is not a
8-49 resident of this state.
8-50 (b) In a suit contesting the denial of access under Section
8-51 611.0045, the burden of proving that the denial was proper is on
8-52 the professional who denied the access.
8-53 (c) The aggrieved person also has a civil cause of action
8-54 for damages.
8-55 SECTION 1.14. Subchapter A, Chapter 462, Health and Safety
8-56 Code, is amended by adding Section 462.009 to read as follows:
8-57 Sec. 462.009. CONSENT TO TREATMENT. (a) A patient
8-58 receiving treatment in a treatment facility is entitled to refuse a
8-59 medication, therapy, or treatment unless:
8-60 (1) the patient is younger than 16 years of age and
8-61 the patient's parent, managing conservator, or guardian consents to
8-62 the medication, therapy, or treatment on behalf of the patient;
8-63 (2) the patient has been adjudicated to be incompetent
8-64 to manage the patient's personal affairs or to make a decision to
8-65 refuse the medication, therapy, or treatment and the patient's
8-66 guardian of the person or another person legally authorized to
8-67 consent to medical treatment consents to the medication, therapy,
8-68 or treatment on behalf of the patient; or
8-69 (3) a physician treating the patient determines that
8-70 the medication is necessary to prevent imminent serious physical
9-1 harm to the patient or to another individual and the physician
9-2 issues a written order, or a verbal order if authenticated in
9-3 writing by the physician within 24 hours, to administer the
9-4 medication to the patient.
9-5 (b) The decision of a guardian or of a person legally
9-6 authorized to consent to medical treatment on the patient's behalf
9-7 under Subsection (a)(2) must be based on knowledge of what the
9-8 patient would desire, if known.
9-9 (c) A patient's refusal to receive medication, therapy, or
9-10 treatment under Subsection (a), or a patient's attempt to refuse if
9-11 the patient's right to refuse is limited by that subsection, shall
9-12 be documented in the patient's clinical record together with the
9-13 patient's expressed reason for refusal.
9-14 (d) If a physician orders a medication to be administered to
9-15 a patient under Subsection (a)(3), the physician shall document in
9-16 the patient's clinical record in specific medical and behavioral
9-17 terms the reasons for the physician's determination of the
9-18 necessity of the order.
9-19 (e) Consent given by a patient or by a person authorized by
9-20 law to consent to treatment on the patient's behalf for the
9-21 administration of a medication, therapy, or treatment is valid only
9-22 if:
9-23 (1) the consent is given voluntarily and without
9-24 coercive or undue influence;
9-25 (2) before administration of the medication, therapy,
9-26 or treatment, the treating physician explains to the patient and to
9-27 the person giving consent, in simple, nontechnical language:
9-28 (A) the specific condition to be treated;
9-29 (B) the beneficial effects on that condition
9-30 expected from the medication, therapy, or treatment;
9-31 (C) the probable health and mental health
9-32 consequences of not consenting to the medication, therapy, or
9-33 treatment;
9-34 (D) the side effects and risks associated with
9-35 the medication, therapy, or treatment;
9-36 (E) the generally accepted alternatives to the
9-37 medication, therapy, or treatment, if any, and whether an
9-38 alternative might be appropriate for the patient; and
9-39 (F) the proposed course of the medication,
9-40 therapy, or treatment; and
9-41 (3) the informed consent is evidenced in the patient's
9-42 clinical record by a signed form prescribed by the commission for
9-43 this purpose or by a statement of the treating physician that
9-44 documents that consent was given by the appropriate person and the
9-45 circumstances under which the consent was obtained.
9-46 (f) A person who consents to the administration of a
9-47 medication, therapy, or treatment may revoke the consent at any
9-48 time and for any reason, regardless of the person's capacity.
9-49 Revocation of consent is effective immediately and further
9-50 medication, therapy, or treatment may not be administered unless
9-51 new consent is obtained in accordance with this section.
9-52 (g) Consent given by a patient or by a person authorized by
9-53 law to consent to treatment on the patient's behalf applies to a
9-54 series of doses of medication or to multiple therapies or
9-55 treatments for which consent was previously granted. If the
9-56 treating physician obtains new information relating to a
9-57 medication, therapy, or treatment for which consent was previously
9-58 obtained, the physician must explain the new information and obtain
9-59 new consent.
9-60 SECTION 1.15. Section 462.024, Health and Safety Code, is
9-61 amended to read as follows:
9-62 Sec. 462.024. APPLICATION FOR COURT-ORDERED TREATMENT DURING
9-63 VOLUNTARY INPATIENT CARE. (a) An application for court-ordered
9-64 treatment may not be filed against a patient receiving voluntary
9-65 care under this subchapter unless:
9-66 (1) a request for release of the patient has been
9-67 filed; or
9-68 (2) in the <facility administrator's> opinion of the
9-69 physician responsible for the patient's treatment, the patient
9-70 meets the criteria for court-ordered treatment and:
10-1 (A) is absent from the facility without
10-2 authorization; <or>
10-3 (B) <refuses or> is unable to consent to
10-4 appropriate and necessary treatment; or
10-5 (C) refuses to consent to necessary and
10-6 appropriate treatment recommended by the physician responsible for
10-7 the patient's treatment and that physician completes a certificate
10-8 of medical examination for chemical dependency that, in addition to
10-9 the information required by Section 462.064, includes the opinion
10-10 of the physician that:
10-11 (i) there is no reasonable alternative to
10-12 the treatment recommended by the physician; and
10-13 (ii) the patient will not benefit from
10-14 continued inpatient care without the recommended treatment.
10-15 (b) The physician responsible for the patient's treatment
10-16 shall notify the patient if the physician intends to file an
10-17 application for court-ordered treatment.
10-18 SECTION 1.16. (a) Not later than October 31, 1993, the
10-19 Texas Board of Mental Health and Mental Retardation shall appoint
10-20 an advisory task force on prescription medications composed of at
10-21 least the following persons:
10-22 (1) one licensed psychiatrist;
10-23 (2) one licensed psychologist;
10-24 (3) one certified social worker;
10-25 (4) one licensed professional counselor;
10-26 (5) one licensed chemical dependency counselor;
10-27 (6) two persons who have received mental health
10-28 services, either voluntarily or involuntarily, during the two years
10-29 preceding the date of the person's appointment;
10-30 (7) one member from each of two private associations
10-31 of persons who advocate on the behalf of or in the interest of
10-32 persons with mental illness;
10-33 (8) one licensed psychiatric nurse; and
10-34 (9) one licensed pharmacist.
10-35 (b) The board may appoint additional members as it considers
10-36 appropriate.
10-37 (c) The advisory task force shall designate one member to
10-38 serve as presiding officer.
10-39 (d) The advisory task force shall recommend to the Texas
10-40 Board of Mental Health and Mental Retardation information
10-41 concerning different types of prescription medications, based on
10-42 generally accepted clinical and medical standards and practices,
10-43 that shall be provided to each person who may receive prescription
10-44 medication while receiving inpatient mental health services. The
10-45 task force shall make its recommendations not later than February
10-46 1, 1994.
10-47 (e) The advisory task force may conduct public hearings on
10-48 desirable information to be provided to a person who may receive
10-49 prescription medication.
10-50 (f) Members of the advisory task force receive no
10-51 compensation but are entitled to reimbursement for reasonable
10-52 expenses incurred in performing official duties in accordance with
10-53 the General Appropriations Act.
10-54 (g) In adopting rules under Section 571.0065, Health and
10-55 Safety Code, as added by this Act, the Texas Board of Mental Health
10-56 and Mental Retardation shall consider the recommendations of the
10-57 advisory task force on prescription medications appointed under
10-58 this section. The board shall adopt rules under Section 571.0065,
10-59 Health and Safety Code, not later than May 1, 1994.
10-60 SECTION 1.17. (a) The changes in law made by this article
10-61 apply only to consent for the administration of a medication,
10-62 therapy, or treatment to a person that is given on or after the
10-63 effective date of this article.
10-64 (b) Valid consent for the administration of a medication,
10-65 therapy, or treatment to a person that is given before the
10-66 effective date of this article remains valid and continues in
10-67 effect until consent is withdrawn by the person who gave consent or
10-68 by a person who is entitled to refuse the medication, therapy, or
10-69 treatment.
10-70 ARTICLE 2
11-1 SECTION 2.01. Section 311.002, Health and Safety Code, is
11-2 amended by amending Subsections (d), (e), and (f) and adding
11-3 Subsections (g) and (h) to read as follows:
11-4 (d) A hospital shall provide an itemized statement of billed
11-5 services to a third party payor who is actually or potentially
11-6 responsible for paying all or part of the billed services provided
11-7 to a patient and who has received a claim for payment of those
11-8 services. To be entitled to receive a statement, the third party
11-9 payor must request the statement from the hospital and must have
11-10 received a claim for payment. The request must be made not later
11-11 than one year after the date on which the payor received the claim
11-12 for payment. The hospital shall provide the statement to the payor
11-13 not later than the 10th day after the date on which the payor
11-14 requests the statement. If a third party payor receives a claim
11-15 for payment of part but not all of the billed services, the third
11-16 party payor may request an itemized statement of only the billed
11-17 services for which payment is claimed or to which any deduction or
11-18 copayment applies.
11-19 (e) If a person, including a third party payor, requests
11-20 more than two copies of the statement, the hospital may charge a
11-21 reasonable fee for the third and subsequent copies provided to that
11-22 person. The fee may not exceed the hospital's cost to copy,
11-23 process, and deliver the copy to the person.
11-24 (f) <(e)> The Texas Department of Health or other
11-25 appropriate licensing agency may enforce this section by injunction
11-26 or by any other appropriate remedy, including suspending, revoking,
11-27 or refusing to renew a hospital's license.
11-28 (g) In this section, "hospital" includes:
11-29 (1) a treatment facility licensed under Chapter 464;
11-30 and
11-31 (2) a mental health facility licensed under Chapter
11-32 577.
11-33 (h) <(f)> This section does not apply to a hospital
11-34 maintained or operated by the federal government.
11-35 SECTION 2.02. Subchapter A, Chapter 311, Health and Safety
11-36 Code, is amended by adding Section 311.0025 to read as follows:
11-37 Sec. 311.0025. AUDITS OF BILLING. (a) A hospital,
11-38 treatment facility, mental health facility, or health care
11-39 professional may not submit to a patient or a third party payor a
11-40 bill for a treatment that the hospital, facility, or professional
11-41 knows was not provided or knows was improper, unreasonable, or
11-42 medically or clinically unnecessary.
11-43 (b) If the appropriate licensing agency receives a complaint
11-44 alleging a violation of Subsection (a), the agency may audit the
11-45 billings and patient records of the hospital, treatment facility,
11-46 mental health facility, or health care professional.
11-47 (c) A hospital, treatment facility, mental health facility,
11-48 or health care professional that violates Subsection (a) is subject
11-49 to disciplinary action, including denial, revocation, suspension,
11-50 or nonrenewal of the license of the hospital, facility, or
11-51 professional. Disciplinary action taken under this section is in
11-52 addition to any other civil, administrative, or criminal penalty
11-53 provided by law.
11-54 (d) A health care professional may not order or direct a
11-55 hospital, treatment facility, or mental health facility to provide
11-56 treatment that the professional knows is improper, unreasonable, or
11-57 medically or clinically unnecessary. If a hospital or facility is
11-58 denied reimbursement for treatment because a health care
11-59 professional orders or directs treatment in violation of this
11-60 subsection, the professional shall reimburse the hospital or
11-61 facility for the treatment not later than the 30th day after the
11-62 date on which the professional receives a final determination of
11-63 violation.
11-64 (e) Each health care regulatory agency by rule shall
11-65 prescribe what constitutes "improper, unreasonable, or medically or
11-66 clinically unnecessary" treatment.
11-67 (f) In this section:
11-68 (1) "Health care professional" means an individual
11-69 licensed, certified, or regulated by a health care regulatory
11-70 agency who is eligible for reimbursement for treatment ordered or
12-1 rendered by that professional.
12-2 (2) "Hospital" means a hospital licensed under Chapter
12-3 241.
12-4 (3) "Mental health facility" means a mental health
12-5 facility licensed under Chapter 577.
12-6 (4) "Treatment facility" means a treatment facility
12-7 licensed under Chapter 464.
12-8 ARTICLE 3
12-9 SECTION 3.01. Except as otherwise provided by this Act, this
12-10 Act takes effect immediately.
12-11 SECTION 3.02. The importance of this legislation and the
12-12 crowded condition of the calendars in both houses create an
12-13 emergency and an imperative public necessity that the
12-14 constitutional rule requiring bills to be read on three several
12-15 days in each house be suspended, and this rule is hereby suspended,
12-16 and that this Act take effect and be in force according to its
12-17 terms, and it is so enacted.
12-18 * * * * *
12-19 Austin,
12-20 Texas
12-21 March 19, 1993
12-22 Hon. Bob Bullock
12-23 President of the Senate
12-24 Sir:
12-25 We, your Committee on Health and Human Services to which was
12-26 referred S.B. No. 207, have had the same under consideration, and I
12-27 am instructed to report it back to the Senate with the
12-28 recommendation that it do not pass, but that the Committee
12-29 Substitute adopted in lieu thereof do pass and be printed.
12-30 Zaffirini,
12-31 Chair
12-32 * * * * *
12-33 WITNESSES
12-34 FOR AGAINST ON
12-35 ___________________________________________________________________
12-36 Name: Dan Morales x
12-37 Representing: State of Texas
12-38 City: Austin
12-39 -------------------------------------------------------------------
12-40 Name: Dr. Charles Arnold x
12-41 Representing: self
12-42 City: San Antonio
12-43 -------------------------------------------------------------------
12-44 Name: Davis F. Briones, M.D. x
12-45 Representing: TSPP & TMA
12-46 City: El Paso
12-47 -------------------------------------------------------------------
12-48 Name: Douglas Gough Cameron x
12-49 Representing: CMTE for Truth in Psychiatry
12-50 City: San Marcos
12-51 -------------------------------------------------------------------
12-52 Name: Florence Winn-Salmon x
12-53 Representing: Tx Alliance-Mentally Ill
12-54 City: Austin
12-55 -------------------------------------------------------------------
12-56 Name: Ben Marroquin x
12-57 Representing: MHMR
12-58 City: Austin
12-59 -------------------------------------------------------------------
12-60 Name: Maurice Shaw x
12-61 Representing: TDH
12-62 City: Austin
12-63 -------------------------------------------------------------------
12-64 Name: Jerry Boswell x
12-65 Representing: Citzens Comm on Human Rights
12-66 City: Austin
12-67 -------------------------------------------------------------------
12-68 Name: Tom Wright x
12-69 Representing: Citizens Comm on Human Rights
12-70 City: Houston
13-1 -------------------------------------------------------------------
13-2 Name: Mary Dees x
13-3 Representing: Tx Mental Health Consumers
13-4 City: Austin
13-5 -------------------------------------------------------------------
13-6 Name: Jeannie Christine Warren x
13-7 Representing: self
13-8 City: Dallas
13-9 -------------------------------------------------------------------
13-10 Name: Wylie Jordan x
13-11 Representing: self
13-12 City: Austin
13-13 -------------------------------------------------------------------
13-14 FOR AGAINST ON
13-15 ___________________________________________________________________
13-16 Name: Dr. Alaire Lowry x
13-17 Representing: Tx Psychological
13-18 City: Austin
13-19 -------------------------------------------------------------------
13-20 Name: Don Cavness x
13-21 Representing: Tx Psychological
13-22 City: Austin
13-23 -------------------------------------------------------------------
13-24 Name: Nancy Sims x
13-25 Representing: Tx Business Group on Health
13-26 City: Austin
13-27 -------------------------------------------------------------------
13-28 Name: Cathy Campbell x
13-29 Representing: TDMHMR
13-30 City: Austin
13-31 -------------------------------------------------------------------
13-32 Name: Deborah Hiser x
13-33 Representing: Advocacy, Inc.
13-34 City: Austin
13-35 -------------------------------------------------------------------
13-36 Name: Mike Ezzel x
13-37 Representing: TCADA
13-38 City: Austin
13-39 -------------------------------------------------------------------
13-40 Name: Cynthia Hopkins x
13-41 Representing: Tx Mental Health Consumers
13-42 City: Austin
13-43 -------------------------------------------------------------------
13-44 Name: Edward Sledge x
13-45 Representing: self
13-46 City: Austin
13-47 -------------------------------------------------------------------
13-48 Name: Joanne P. Hopkins x
13-49 Representing: National Medical Enterprises
13-50 City: Austin
13-51 -------------------------------------------------------------------
13-52 Name: Marcia Baum x
13-53 Representing: NASW
13-54 City: Austin
13-55 -------------------------------------------------------------------
13-56 Name: Christine Devall x
13-57 Representing: Mental Health Assn
13-58 City: Austin
13-59 -------------------------------------------------------------------
13-60 Name: Mark D. Chouteau x
13-61 Representing: Attorney General's Office
13-62 City: Austin
13-63 -------------------------------------------------------------------
13-64 Name: Lisa McGiffert x
13-65 Representing: Consumers Union
13-66 City: Austin
13-67 -------------------------------------------------------------------
13-68 Name: Kevin O'Hanlon x
13-69 Representing: TEA
13-70 City: Austin
14-1 -------------------------------------------------------------------