BG S.B. 1081 75(R) BILL ANALYSIS PUBLIC HEALTH S.B. 1081 By: Barrientos (Maxey) May 8, 1997 Committee Report (Unamended) BACKGROUND With the current cost-cutting emphasis in the health care delivery system, registered nurses can find themselves being requested to engage in conduct they believe is unsafe and in violation of a RN's duty to a patient. Article 4525d was added to the Nursing Practice Act in 1995 to provide protection to RNs who find themselves in such situations by prohibiting employers from terminating or disciplining a RN who refuses to engage in conduct that violates the Nursing Practice Act. However, Article 4525d provides no option to RNs who believe they are being asked to engage in conduct that violates their duty to the patient except to refuse to engage in the conduct and to seek redress if they are terminated or otherwise disciplined for their actions. Consequently, RNs still find themselves faced with the choice of whether to engage in the conduct and risk action against their license by the Board of Nurse Examiners or refuse to engage in the conduct and risk disciplinary action by their employer. The RN's dilemma is exacerbated by the fact that the question of what is a RN's duty to a patient in a particular situation can be a difficult question to answer and one on which reasonable nurses can genuinely disagree. PURPOSE S.B. 1081 provides regulations regarding peer review protections for registered nurses when refusing to engage in conduct that they, in good faith, believe is unsafe or violates a RN's duty to a patient. RULEMAKING AUTHORITY It is the committee's opinion that this bill grants additional rulemaking authority to the Board of Health in SECTION 2 (Section 241.026(a)(6), Health and Safety Code). SECTION BY SECTION ANALYSIS SECTION 1. Amends Article 4525d, Revised Statutes, entitled "Protection for Refusal to Engage in Certain Conduct", as follows: Subsection (c) adds language to allow a nurse to request a finding by a nursing peer review committee of whether conduct violates duty to a patient as specified. Allows a nurse who in good faith requests a peer review determination as specified to engage in the conduct as specified pending the review and is not subject to reporting requirements as specified and may not be disciplined as specified. Requires the findings of the peer review committee to be considered in a disciplinary decision, but specifies that those findings are not binding as specified. Prohibits disciplining or discriminating against a nurse for making a peer review request as specified. Requires the medical staff or medical director to be requested to make a determination as to the medical reasonableness of a physician's order if the conduct for which the peer review is requested involves the medical reasonableness of an order. Establishes that a registered nurse's rights under this article may not be nullified by contract. Subsection (d) makes a conforming change. Subsection (e) adds the definition for "duty to a patient" as used in this article. Makes conforming changes. SECTION 2. Amends Section 241.026(a), Health and Safety Code, by adding a new Subsection (6) to include compliance with nursing peer review under the law, as specified, and the rules of the Board of Nurse Examiners relating to peer review as an issue that must be addressed in Board of Health rules governing hospitals. SECTION 3. Effective date is September 1, 1997 SECTION 4. Emergency Clause.