By Rosson S.B. No. 1161
74R7107 KLL-F
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to out-of-hospital do-not-resuscitate orders; providing
1-3 penalties.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Subtitle A, Title 8, Health and Safety Code, is
1-6 amended by adding Chapter 674 to read as follows:
1-7 Sec. 674.001. DEFINITIONS. In this chapter:
1-8 (1) "Attending physician" means the physician who has
1-9 primary responsibility for a person's treatment and care.
1-10 (2) "Board" means the Texas Board of Health.
1-11 (3) "Cardiopulmonary resuscitation" includes a
1-12 component of cardiopulmonary resuscitation.
1-13 (4) "Competent" means possessing the ability, based on
1-14 reasonable medical judgment, to understand and appreciate the
1-15 nature and consequences of a treatment decision, including the
1-16 significant benefits and harms of, and reasonable alternatives to,
1-17 a proposed treatment decision.
1-18 (5) "Declarant" means a person who has executed or
1-19 issued an out-of-hospital do-not-resuscitate order under this
1-20 chapter.
1-21 (6) "Department" means the Texas Department of Health.
1-22 (7) "DNR identification device" means an
1-23 identification device specified by the board under Section 674.023
1-24 that is worn for the purpose of identifying a person who has
2-1 executed or issued an out-of-hospital DNR order or on whose behalf
2-2 an out-of-hospital DNR order has been executed or issued under this
2-3 chapter.
2-4 (8) "Durable power of attorney for health care" means
2-5 a document delegating to an agent the authority to make health care
2-6 decisions for a person in accordance with Chapter 135, Civil
2-7 Practice and Remedies Code.
2-8 (9) "Emergency medical services" has the meaning
2-9 assigned by Section 773.003.
2-10 (10) "Emergency medical services personnel" has the
2-11 meaning assigned by Section 773.003.
2-12 (11) "Health care professionals" means physicians,
2-13 nurses, and emergency medical services personnel and, unless the
2-14 context requires otherwise, includes hospital emergency personnel.
2-15 (12) "Incompetent" means lacking the ability, based on
2-16 reasonable medical judgment, to understand and appreciate the
2-17 nature and consequences of a treatment decision, including the
2-18 significant benefits and harms of, and reasonable alternatives to,
2-19 a proposed treatment decision.
2-20 (13) "Life-sustaining procedure" means a medical
2-21 procedure, treatment, or intervention that uses mechanical or other
2-22 artificial means to sustain, restore, or supplant a spontaneous
2-23 vital function and, when applied to a person in a terminal
2-24 condition, serves only to prolong the process of dying. The term
2-25 does not include the administration of medication or the
2-26 performance of a medical procedure considered to be necessary to
2-27 provide comfort or care or to alleviate pain.
3-1 (14) "Out-of-hospital DNR order":
3-2 (A) means a legally binding out-of-hospital
3-3 do-not-resuscitate order, in the form specified by the board under
3-4 Section 674.003, prepared and signed by the attending physician of
3-5 a person who has been diagnosed as having a terminal condition,
3-6 that documents the instructions of a person or the person's legally
3-7 authorized representative and directs health care professionals
3-8 acting in an out-of-hospital setting not to initiate or continue
3-9 the following life-sustaining procedures:
3-10 (i) cardiopulmonary resuscitation;
3-11 (ii) endotracheal intubation or other
3-12 means of advanced airway management;
3-13 (iii) artificial ventilation;
3-14 (iv) defibrillation;
3-15 (v) transcutaneous cardiac pacing;
3-16 (vi) the administration of cardiac
3-17 resuscitation medications; and
3-18 (vii) other life-sustaining procedures
3-19 specified by the board under Section 674.023(a); and
3-20 (B) does not include authorization to withhold
3-21 medical interventions or therapies considered necessary to provide
3-22 comfort or care or to alleviate pain.
3-23 (15) "Out-of-hospital setting" means any setting
3-24 outside of a licensed acute care hospital in which health care
3-25 professionals are called for assistance, including long-term care
3-26 facilities, in-patient hospice facilities, private homes, and
3-27 vehicles during transport.
4-1 (16) "Physician" means a physician licensed by the
4-2 Texas State Board of Medical Examiners or a properly credentialed
4-3 physician who holds a commission in the uniformed services of the
4-4 United States and who is serving on active duty in this state.
4-5 (17) "Proxy" means a person designated and authorized
4-6 by a directive executed or issued in accordance with Chapter 672 to
4-7 make a treatment decision for another person in the event the other
4-8 person becomes comatose, incompetent, or otherwise mentally or
4-9 physically incapable of communication.
4-10 (18) "Qualified relatives" means those persons
4-11 authorized to execute or issue an out-of-hospital DNR order on
4-12 behalf of a person who is comatose, incompetent, or otherwise
4-13 mentally or physically incapable of communication under Section
4-14 674.008.
4-15 (19) "Statewide out-of-hospital DNR protocol" means a
4-16 set of statewide standardized procedures adopted by the board under
4-17 Section 674.023 for withholding cardiopulmonary resuscitation and
4-18 certain other life-sustaining procedures by health care
4-19 professionals acting in out-of-hospital settings.
4-20 (20) "Terminal condition" means an incurable or
4-21 irreversible condition caused by injury, disease, or illness that
4-22 would produce death without the application of life-sustaining
4-23 procedures, according to reasonable medical judgment, and in which
4-24 the application of life-sustaining procedures serves only to
4-25 postpone the moment of the person's death.
4-26 Sec. 674.002. OUT-OF-HOSPITAL DNR ORDER; DIRECTIVE TO
4-27 PHYSICIANS. (a) A competent person who has been diagnosed by a
5-1 physician as having a terminal condition may at any time execute a
5-2 written out-of-hospital DNR order directing health care
5-3 professionals acting in an out-of-hospital setting to withhold
5-4 cardiopulmonary resuscitation and certain other life-sustaining
5-5 procedures designated by the board.
5-6 (b) The declarant must sign the out-of-hospital DNR order in
5-7 the presence of two witnesses, and those witnesses must sign the
5-8 order. The attending physician of the declarant must sign the
5-9 order and shall make the fact of the existence of the order and the
5-10 reasons for execution of the order a part of the declarant's
5-11 medical record.
5-12 (c) A witness must have the same qualifications as those
5-13 provided by Section 672.003(c).
5-14 (d) If the person is incompetent but previously executed or
5-15 issued a directive to physicians in accordance with Chapter 672,
5-16 the physician may rely on the directive as the person's
5-17 instructions to issue an out-of-hospital DNR order and shall place
5-18 a copy of the directive in the person's medical record. The
5-19 physician shall sign the order in lieu of the person signing under
5-20 Subsection (b).
5-21 (e) If the person is incompetent but previously executed or
5-22 issued a directive to physicians in accordance with Chapter 672
5-23 designating a proxy, the proxy may make any decisions required of
5-24 the designating person as to an out-of-hospital DNR order and shall
5-25 sign the order in lieu of the person signing under Subsection (b).
5-26 (f) If the person is now incompetent but previously executed
5-27 or issued a durable power of attorney for health care in accordance
6-1 with Chapter 135, Civil Practice and Remedies Code, designating an
6-2 agent, the agent may make any decisions required of the designating
6-3 person as to an out-of-hospital DNR order and shall sign the order
6-4 in lieu of the person signing under Subsection (b).
6-5 (g) The board, on the recommendation of the department,
6-6 shall by rule adopt procedures for the disposition and maintenance
6-7 of records of an original out-of-hospital DNR order and any copies
6-8 of the order.
6-9 (h) An out-of-hospital DNR order is effective on its
6-10 execution.
6-11 Sec. 674.003. FORM OF OUT-OF-HOSPITAL DNR ORDER. (a) A
6-12 written out-of-hospital DNR order shall be in the standard form
6-13 specified by board rule as recommended by the department.
6-14 (b) The standard form of an out-of-hospital DNR order
6-15 specified by the board must, at a minimum, contain the following:
6-16 (1) a distinctive single-page format that readily
6-17 identifies the document as an out-of-hospital DNR order;
6-18 (2) a title that readily identifies the document as an
6-19 out-of-hospital DNR order;
6-20 (3) the printed or typed name of the person;
6-21 (4) a statement that the physician signing the
6-22 document is the attending physician of the person, that the
6-23 physician has diagnosed the person as having a terminal condition,
6-24 and that the physician is directing health care professionals
6-25 acting in out-of-hospital settings not to initiate or continue
6-26 certain life-sustaining procedures on behalf of the person, and a
6-27 listing of those procedures not to be initiated or continued;
7-1 (5) a statement that the person understands that the
7-2 person may revoke the out-of-hospital DNR order at any time by
7-3 destroying the order and removing the DNR identification device, if
7-4 any, or by communicating to health care professionals at the scene
7-5 the person's desire to revoke the out-of-hospital DNR order;
7-6 (6) places for the printed names and signatures of the
7-7 witnesses and attending physician of the person and the medical
7-8 license number of the attending physician;
7-9 (7) a separate section for execution of the document
7-10 by the legal guardian of the person, the person's proxy, an agent
7-11 of the person having a durable power of attorney for health care,
7-12 or the attending physician attesting to the issuance of an
7-13 out-of-hospital DNR order by nonwritten means of communication or
7-14 acting in accordance with a previously executed or previously
7-15 issued directive to physicians under Section 674.002(d) that
7-16 includes the following:
7-17 (A) a statement that the legal guardian, the
7-18 proxy, the agent, the person by nonwritten means of communication,
7-19 or the physician directs that the listed life-sustaining procedures
7-20 should not be initiated or continued in behalf of the person; and
7-21 (B) places for the printed names and signatures
7-22 of the witnesses and, as applicable, the legal guardian, proxy,
7-23 agent, or physician;
7-24 (8) a separate section for execution of the document
7-25 by at least two qualified relatives of the person when the person
7-26 does not have a legal guardian, proxy, or agent having a durable
7-27 power of attorney for health care and is comatose, incompetent, or
8-1 otherwise mentally or physically incapable of communication,
8-2 including:
8-3 (A) a statement that the relatives of the person
8-4 are qualified to make a treatment decision to withhold
8-5 cardiopulmonary resuscitation and certain other designated
8-6 life-sustaining procedures under Section 674.008 and, based on the
8-7 known desires of the person or a determination of the best interest
8-8 of the person, direct that the listed life-sustaining procedures
8-9 should not be initiated or continued in behalf of the person; and
8-10 (B) places for the printed names and signatures
8-11 of the witnesses and qualified relatives of the person;
8-12 (9) a place for entry of the date of execution of the
8-13 document;
8-14 (10) a statement that the document is in effect on the
8-15 date of its execution and remains in effect until the death of the
8-16 person or until the document is revoked;
8-17 (11) a statement that the document must accompany the
8-18 person during transport;
8-19 (12) a statement regarding the proper disposition of
8-20 the document or copies of the document, as the board determines
8-21 appropriate; and
8-22 (13) a statement at the bottom of the document, with
8-23 places for the signature of each person executing the document,
8-24 that the document has been properly completed.
8-25 (c) The board may, by rule and as recommended by the
8-26 department, modify the standard form of the out-of-hospital DNR
8-27 order described by Subsection (b) in order to accomplish the
9-1 purposes of this chapter.
9-2 Sec. 674.004. ISSUANCE OF OUT-OF-HOSPITAL DNR ORDER BY
9-3 NONWRITTEN COMMUNICATION. (a) A competent person who is an adult
9-4 may issue an out-of-hospital DNR order by nonwritten communication.
9-5 (b) A declarant must issue the nonwritten out-of-hospital
9-6 DNR order in the presence of the attending physician and two
9-7 witnesses. The witnesses must possess the same qualifications as
9-8 those provided by Section 672.003(c).
9-9 (c) The attending physician and witnesses shall sign the
9-10 out-of-hospital DNR order in that place of the document provided by
9-11 Section 674.003(b)(7) and the attending physician shall sign the
9-12 document in the place required by Section 674.003(b)(13). The
9-13 physician shall make the fact of the existence of the
9-14 out-of-hospital DNR order a part of the declarant's medical record
9-15 and the witnesses shall sign that entry in the medical record.
9-16 (d) An out-of-hospital DNR order issued in the manner
9-17 provided by this section is valid and shall be honored by
9-18 responding health care professionals as if executed in the manner
9-19 provided by Section 674.002.
9-20 Sec. 674.005. EXECUTION OF OUT-OF-HOSPITAL DNR ORDER ON
9-21 BEHALF OF A MINOR. The following persons may execute an
9-22 out-of-hospital DNR order on behalf of a minor:
9-23 (1) the minor's parents;
9-24 (2) the minor's legal guardian; or
9-25 (3) the minor's managing conservator.
9-26 Sec. 674.006. DESIRE OF PERSON SUPERSEDES OUT-OF-HOSPITAL
9-27 DNR ORDER. The desire of a competent person, including a competent
10-1 minor, supersedes the effect of an out-of-hospital DNR order
10-2 executed or issued by or on behalf of the person when the desire is
10-3 communicated to responding health care professionals as provided by
10-4 this chapter.
10-5 Sec. 674.007. PROCEDURE WHEN DECLARANT IS INCOMPETENT OR
10-6 INCAPABLE OF COMMUNICATION. (a) This section applies when a
10-7 person 18 years of age or older has executed or issued an
10-8 out-of-hospital DNR order and subsequently becomes comatose,
10-9 incompetent, or otherwise mentally or physically incapable of
10-10 communication.
10-11 (b) If the adult person has designated a person to make a
10-12 treatment decision as authorized by Section 672.003(d), the
10-13 attending physician and the designated person shall comply with the
10-14 out-of-hospital DNR order.
10-15 (c) If the adult person has not designated a person to make
10-16 a treatment decision as authorized by Section 672.003(d), the
10-17 attending physician shall comply with the out-of-hospital DNR order
10-18 unless the physician believes that the order does not reflect the
10-19 person's present desire.
10-20 Sec. 674.008. PROCEDURE WHEN PERSON HAS NOT EXECUTED OR
10-21 ISSUED OUT-OF-HOSPITAL DNR ORDER AND IS INCOMPETENT OR INCAPABLE OF
10-22 COMMUNICATION. (a) If an adult person has not executed or issued
10-23 an out-of-hospital DNR order and is comatose, incompetent, or
10-24 otherwise mentally or physically incapable of communication, the
10-25 attending physician and the person's legal guardian, proxy, or
10-26 agent having a durable power of attorney for health care may
10-27 execute an out-of-hospital DNR order on behalf of the person.
11-1 (b) If the person does not have a legal guardian, proxy, or
11-2 agent, the attending physician and at least two qualified relatives
11-3 may execute an out-of-hospital DNR order in the same manner as a
11-4 treatment decision made under Section 672.009(b).
11-5 (c) A decision to execute an out-of-hospital DNR order made
11-6 under Subsection (a) or (b) must be based on knowledge of what the
11-7 person would desire, if known.
11-8 (d) An out-of-hospital DNR order executed under Subsection
11-9 (b) must be made in the presence of at least two witnesses who
11-10 possess the same qualifications that are required by Section
11-11 672.003(c).
11-12 (e) The fact that an adult person has not executed or issued
11-13 an out-of-hospital DNR order does not create a presumption that the
11-14 person does not want a treatment decision made to withhold
11-15 cardiopulmonary resuscitation and certain other designated
11-16 life-sustaining procedures designated by the board.
11-17 Sec. 674.009. COMPLIANCE WITH OUT-OF-HOSPITAL DNR ORDER.
11-18 (a) When responding to a call for assistance, health care
11-19 professionals shall honor an out-of-hospital DNR order in
11-20 accordance with the statewide out-of-hospital DNR protocol and,
11-21 where applicable, locally adopted out-of-hospital DNR protocols not
11-22 in conflict with the statewide protocol if:
11-23 (1) the responding health care professionals discover
11-24 an executed or issued out-of-hospital DNR order form on their
11-25 arrival at the scene; and
11-26 (2) the responding health care professionals comply
11-27 with this section.
12-1 (b) If the person is wearing a DNR identification device,
12-2 the responding health care professionals must comply with Section
12-3 674.010.
12-4 (c) The responding health care professionals must establish
12-5 the identity of the person as the person who executed or issued the
12-6 out-of-hospital DNR order or for whom the out-of-hospital DNR order
12-7 was executed or issued.
12-8 (d) The responding health care professionals must determine
12-9 that the out-of-hospital DNR order form appears to be valid in that
12-10 it includes:
12-11 (1) written responses in the places designated on the
12-12 form for the names, signatures, and other information required of
12-13 persons executing or issuing, or witnessing the execution or
12-14 issuance of, the order;
12-15 (2) a date in the place designated on the form for the
12-16 date the order was executed or issued; and
12-17 (3) the signature of the declarant or persons
12-18 executing or issuing the order and the attending physician in the
12-19 appropriate places designated on the form for indicating that the
12-20 order form has been properly completed.
12-21 (e) If the conditions prescribed by Subsections (a)-(d) are
12-22 not determined to apply by the responding health care professionals
12-23 at the scene, the out-of-hospital DNR order may not be honored and
12-24 life-sustaining procedures otherwise required by law or local
12-25 emergency medical services protocols shall be initiated or
12-26 continued. Health care professionals acting in out-of-hospital
12-27 settings are not required to accept or interpret an out-of-hospital
13-1 DNR order that does not meet the requirements of this chapter.
13-2 (f) The out-of-hospital DNR order form, when available, must
13-3 accompany the person during transport.
13-4 (g) A record shall be made and maintained of the
13-5 circumstances of each emergency medical services response in which
13-6 an out-of-hospital DNR order or DNR identification device is
13-7 encountered, in accordance with the statewide out-of-hospital DNR
13-8 protocol and any applicable local out-of-hospital DNR protocol not
13-9 in conflict with the statewide protocol.
13-10 (h) An out-of-hospital DNR order executed or issued and
13-11 documented or evidenced in the manner prescribed by this chapter is
13-12 valid and shall be honored by responding health care professionals
13-13 unless the person or persons found at the scene:
13-14 (1) identify themselves as the declarant or as the
13-15 attending physician, legal guardian, qualified relative, or agent
13-16 of the person having a durable power of attorney for health care
13-17 who executed or issued the out-of-hospital DNR order on behalf of
13-18 the person; and
13-19 (2) request that cardiopulmonary resuscitation or
13-20 certain other life-sustaining procedures designated by the board be
13-21 initiated or continued.
13-22 (i) If the policies of a health care facility preclude
13-23 compliance with the out-of-hospital DNR order of a person or an
13-24 out-of-hospital DNR order issued by an attending physician on
13-25 behalf of a person who is admitted to or a resident of the
13-26 facility, or if the facility is unwilling to accept DNR
13-27 identification devices as evidence of the existence of an
14-1 out-of-hospital DNR order, that facility shall take all reasonable
14-2 steps to notify the person or, if the person is incompetent, the
14-3 person's guardian or the person or persons having authority to make
14-4 health care treatment decisions on behalf of the person, of the
14-5 facility's policy and shall take all reasonable steps to effect the
14-6 transfer of the person to the person's home or to a facility where
14-7 the provisions of this chapter can be carried out.
14-8 Sec. 674.010. DNR IDENTIFICATION DEVICE. (a) A person who
14-9 has a valid out-of-hospital DNR order under this chapter may wear a
14-10 DNR identification device around the neck or on the wrist as
14-11 prescribed by board rule adopted under Section 674.023.
14-12 (b) The presence of a DNR identification device on the body
14-13 of a person is conclusive evidence that the person has executed or
14-14 issued a valid out-of-hospital DNR order or has a valid
14-15 out-of-hospital DNR order executed or issued on the person's
14-16 behalf. Responding health care professionals shall honor the DNR
14-17 identification device as if a valid out-of-hospital DNR order form
14-18 executed or issued by the person were found in the possession of
14-19 the person.
14-20 Sec. 674.011. Duration of Out-of-Hospital DNR Order. An
14-21 out-of-hospital DNR order is effective until it is revoked as
14-22 prescribed by Section 674.012.
14-23 Sec. 674.012. Revocation of Out-of-Hospital DNR Order. (a)
14-24 A declarant may revoke an out-of-hospital DNR order at any time
14-25 without regard to the declarant's mental state or competency. An
14-26 order may be revoked by:
14-27 (1) the declarant or someone in the declarant's
15-1 presence and at the declarant's direction destroying the order form
15-2 and removing the DNR identification device, if any;
15-3 (2) a person who identifies himself or herself as the
15-4 legal guardian, as a qualified relative, or as the agent of the
15-5 declarant having a durable power of attorney for health care who
15-6 executed the out-of-hospital DNR order or another person in the
15-7 person's presence and at the person's direction destroying the
15-8 order form and removing the DNR identification device, if any;
15-9 (3) the declarant communicating the declarant's intent
15-10 to revoke the order; or
15-11 (4) a person who identifies himself or herself as the
15-12 legal guardian, a qualified relative, or the agent of the declarant
15-13 having a durable power of attorney for health care who executed the
15-14 out-of-hospital DNR order orally stating the person's intent to
15-15 revoke the order.
15-16 (b) An oral revocation under Subsection (a)(3) or (a)(4)
15-17 takes effect only when the declarant or a person who identifies
15-18 himself or herself as the legal guardian, a qualified relative, or
15-19 the agent of the declarant having a durable power of attorney for
15-20 health care who executed the out-of-hospital DNR order communicates
15-21 the intent to revoke the order to the responding health care
15-22 professionals or the attending physician at the scene. The
15-23 responding health care professionals shall record the time, date,
15-24 and place of the revocation in accordance with the statewide
15-25 out-of-hospital DNR protocol and rules adopted by the board and any
15-26 applicable local out-of-hospital DNR protocol. The attending
15-27 physician or the physician's designee shall record in the person's
16-1 medical record the time, date, and place of the revocation and, if
16-2 different, the time, date, and place that the physician received
16-3 notice of the revocation. The attending physician or the
16-4 physician's designee shall also enter the word "VOID" on each page
16-5 of the copy of the order in the person's medical record.
16-6 (c) Except as otherwise provided by this chapter, a person
16-7 is not civilly or criminally liable for failure to act on a
16-8 revocation made under this section unless the person has actual
16-9 knowledge of the revocation.
16-10 Sec. 674.013. Reexecution of Out-of-Hospital DNR Order. A
16-11 declarant may at any time reexecute or reissue an out-of-hospital
16-12 DNR order in accordance with the procedures prescribed by Section
16-13 674.002, including reexecution or reissuance after the declarant is
16-14 diagnosed as having a terminal condition.
16-15 Sec. 674.014. CONFLICT WITH NATURAL DEATH ACT OR DURABLE
16-16 POWER OF ATTORNEY FOR HEALTH CARE. To the extent that an
16-17 out-of-hospital DNR order conflicts with a directive or treatment
16-18 decision executed or issued under Chapter 672 or a durable power of
16-19 attorney for health care executed or issued in accordance with
16-20 Chapter 135, Civil Practice and Remedies Code, the instrument
16-21 executed later in time controls.
16-22 Sec. 674.015. Effect of Out-of-Hospital DNR Order on
16-23 Insurance Policy and Premiums. (a) The fact that a person has
16-24 executed or issued an out-of-hospital DNR order under this chapter
16-25 does not:
16-26 (1) restrict, inhibit, or impair in any manner the
16-27 sale, procurement, or issuance of a life insurance policy to that
17-1 person; or
17-2 (2) modify the terms of an existing life insurance
17-3 policy.
17-4 (b) Notwithstanding the terms of any life insurance policy,
17-5 the fact that cardiopulmonary resuscitation or certain other
17-6 life-sustaining procedures designated by the board are withheld
17-7 from an insured person under this chapter does not legally impair
17-8 or invalidate that person's life insurance policy and may not be a
17-9 factor for the purpose of determining the payability of benefits or
17-10 the cause of death under the life insurance policy.
17-11 (c) A physician, health facility, health care provider,
17-12 insurer, or health care service plan may not require a person to
17-13 execute or issue an out-of-hospital DNR order as a condition for
17-14 obtaining insurance for health care services or receiving health
17-15 care services.
17-16 (d) The fact that a person has executed or issued or failed
17-17 to execute or issue an out-of-hospital DNR order under this chapter
17-18 may not be considered in any way in establishing insurance
17-19 premiums.
17-20 Sec. 674.016. Limitation on Liability for Withholding
17-21 Cardiopulmonary Resuscitation and Certain other Life-Sustaining
17-22 Procedures. (a) A health care professional or health care
17-23 facility or entity that in good faith causes cardiopulmonary
17-24 resuscitation or certain other life-sustaining procedures
17-25 designated by the board to be withheld from a person in accordance
17-26 with this chapter is not civilly liable for that action.
17-27 (b) A health care professional or health care facility or
18-1 entity that in good faith participates in withholding
18-2 cardiopulmonary resuscitation or certain other life-sustaining
18-3 procedures designated by the board from a person in accordance with
18-4 this chapter is not civilly liable for that action.
18-5 (c) A health care professional or health care facility or
18-6 entity that in good faith participates in withholding
18-7 cardiopulmonary resuscitation or certain other life-sustaining
18-8 procedures designated by the board from a person in accordance with
18-9 this chapter is not criminally liable or guilty of unprofessional
18-10 conduct as a result of that action.
18-11 (d) A health care professional or health care facility or
18-12 entity that in good faith causes or participates in withholding
18-13 cardiopulmonary resuscitation or certain other life-sustaining
18-14 procedures designated by the board from a person in accordance with
18-15 this chapter and rules adopted under this chapter is not in
18-16 violation of any other licensing or regulatory laws or rules of
18-17 this state and is not subject to any disciplinary action or
18-18 sanction by any licensing or regulatory agency of this state as a
18-19 result of that action.
18-20 Sec. 674.017. Limitation on Liability for Failure to
18-21 Effectuate Out-of-hospital DNR order. (a) A health care
18-22 professional or health care facility or entity that has no actual
18-23 knowledge of an out-of-hospital DNR order is not civilly or
18-24 criminally liable for failing to act in accordance with the order.
18-25 (b) A health care professional or health care facility or
18-26 entity is not civilly or criminally liable for failing to
18-27 effectuate an out-of-hospital DNR order.
19-1 (c) If an attending physician refuses to execute or comply
19-2 with an out-of-hospital DNR order, the physician shall inform the
19-3 person, the legal guardian or qualified relatives of the person, or
19-4 the agent of the person having a durable power of attorney for
19-5 health care and, if the person or another authorized to act on
19-6 behalf of the person so directs, shall make a reasonable effort to
19-7 transfer the person to another physician who is willing to execute
19-8 or comply with an out-of-hospital DNR order.
19-9 Sec. 674.018. Honoring Out-of-hospital DNR Order Does Not
19-10 Constitute Offense of Aiding Suicide. A person does not commit an
19-11 offense under Section 22.08, Penal Code, by withholding
19-12 cardiopulmonary resuscitation or certain other life-sustaining
19-13 procedures designated by the board from a person in accordance with
19-14 this chapter.
19-15 Sec. 674.019. Criminal Penalty; Prosecution. (a) A person
19-16 commits an offense if the person intentionally conceals, cancels,
19-17 defaces, obliterates, or damages another person's out-of-hospital
19-18 DNR order or DNR identification device without that person's
19-19 consent or the consent of the person or persons authorized to
19-20 execute or issue an out-of-hospital DNR order on behalf of the
19-21 person under this chapter. An offense under this subsection is a
19-22 Class A misdemeanor.
19-23 (b) A person is subject to prosecution for criminal homicide
19-24 under Chapter 19, Penal Code, if the person, with the intent to
19-25 cause cardiopulmonary resuscitation or certain other
19-26 life-sustaining procedures designated by the board to be withheld
19-27 from another person contrary to the other person's desires,
20-1 falsifies or forges an out-of-hospital DNR order or intentionally
20-2 conceals or withholds personal knowledge of a revocation and
20-3 thereby directly causes cardiopulmonary resuscitation and certain
20-4 other life-sustaining procedures designated by the board to be
20-5 withheld from the other person with the result that the other
20-6 person's death is hastened.
20-7 Sec. 674.020. PREGNANT PERSONS. A person may not withhold
20-8 cardiopulmonary resuscitation or certain other life-sustaining
20-9 procedures designated by the board under this chapter from a person
20-10 known by the responding health care professionals to be pregnant.
20-11 Sec. 674.021. Mercy Killing Not Condoned. This chapter does
20-12 not condone, authorize, or approve mercy killing or permit an
20-13 affirmative or deliberate act or omission to end life except to
20-14 permit the natural process of dying as provided by this chapter.
20-15 Sec. 674.022. LEGAL RIGHT OR RESPONSIBILITY NOT AFFECTED.
20-16 This chapter does not impair or supersede any legal right or
20-17 responsibility a person may have under a constitution, other
20-18 statute, regulation, or court decision to effect the withholding of
20-19 cardiopulmonary resuscitation or certain other life-sustaining
20-20 procedures designated by the board.
20-21 Sec. 674.023. DUTIES OF DEPARTMENT AND BOARD. (a) The
20-22 board shall, on the recommendation of the department, adopt all
20-23 reasonable and necessary rules to carry out the purposes of this
20-24 chapter, including rules:
20-25 (1) adopting a statewide out-of-hospital DNR order
20-26 protocol that sets out standard procedures for the withholding of
20-27 cardiopulmonary resuscitation and certain other life-sustaining
21-1 procedures by health care professionals acting in out-of-hospital
21-2 settings;
21-3 (2) designating life-sustaining procedures that may be
21-4 included in an out-of-hospital DNR order, including all procedures
21-5 listed in Section 674.001(14)(A)(i)-(vi); and
21-6 (3) governing recordkeeping in circumstances in which
21-7 an out-of-hospital DNR order or DNR identification device is
21-8 encountered by responding health care professionals.
21-9 (b) The rules adopted by the board under Subsection (a) are
21-10 not effective until approved by the Texas State Board of Medical
21-11 Examiners.
21-12 (c) Local emergency medical services authorities may adopt
21-13 local out-of-hospital DNR order protocols if the local protocols do
21-14 not conflict with the statewide out-of-hospital DNR order protocol
21-15 adopted by the board.
21-16 (d) The board by rule shall specify a distinctive standard
21-17 design for a necklace and a bracelet DNR identification device that
21-18 signifies, when worn by a person, that the possessor has executed
21-19 or issued a valid out-of-hospital DNR order under this chapter or
21-20 is a person for whom a valid out-of-hospital DNR order has been
21-21 executed or issued.
21-22 (e) The department shall report to the board from time to
21-23 time regarding issues identified in emergency medical services
21-24 responses in which an out-of-hospital DNR order or DNR
21-25 identification device is encountered. The report may contain
21-26 recommendations to the board for necessary modifications to the
21-27 form of the standard out-of-hospital DNR order or the designated
22-1 life-sustaining procedures listed in the standard out-of-hospital
22-2 DNR order, the statewide out-of-hospital DNR order protocol, or the
22-3 DNR identification devices.
22-4 Sec. 674.024. Recognition of Out-of-Hospital DNR Order
22-5 Executed or Issued in Other State. An out-of-hospital DNR order
22-6 executed, issued, or authorized in another state or a territory or
22-7 possession of the United States in compliance with the law of that
22-8 jurisdiction is effective for purposes of this chapter.
22-9 SECTION 2. This Act takes effect January 1, 1996.
22-10 SECTION 3. The importance of this legislation and the
22-11 crowded condition of the calendars in both houses create an
22-12 emergency and an imperative public necessity that the
22-13 constitutional rule requiring bills to be read on three several
22-14 days in each house be suspended, and this rule is hereby suspended.