1-1     By:  Dukes (Senate Sponsor - Wentworth)                H.B. No. 723

 1-2           (In the Senate - Received from the House April 18, 1997;

 1-3     April 22, 1997, read first time and referred to Committee on Health

 1-4     and Human Services; May 18, 1997, reported adversely, with

 1-5     favorable Committee Substitute by the following vote:  Yeas 9, Nays

 1-6     0; May 18, 1997, sent to printer.)

 1-7     COMMITTEE SUBSTITUTE FOR H.B. No. 723                   By:  Nelson

 1-8                            A BILL TO BE ENTITLED

 1-9                                   AN ACT

1-10     relating to informed consent before the performance of a

1-11     hysterectomy.

1-12           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

1-13           SECTION 1.  Subchapter F, Medical Liability and Insurance

1-14     Improvement Act of Texas (Article 4590i, Vernon's Texas Civil

1-15     Statutes), is amended by adding Section 6.08 to read as follows:

1-16           Sec. 6.08.  INFORMED CONSENT FOR HYSTERECTOMIES.  (a)  The

1-17     panel shall develop and prepare written materials to inform a

1-18     patient or person authorized to consent for a patient of the risks

1-19     and hazards of a hysterectomy.

1-20           (b)  The materials shall be available in English, Spanish,

1-21     and any other language the panel considers appropriate.  The

1-22     information must be presented in a manner understandable to a

1-23     layperson.

1-24           (c)  The materials must include:

1-25                 (1)  a notice that a decision made at any time to

1-26     refuse to undergo a hysterectomy will not result in the withdrawal

1-27     or withholding of any benefits provided by programs or projects

1-28     receiving federal funds or otherwise affect the patient's right to

1-29     future care or treatment;

1-30                 (2)  the name of the person providing and explaining

1-31     the materials;

1-32                 (3)  a statement that the patient or person authorized

1-33     to consent for the patient understands that the hysterectomy is

1-34     permanent and nonreversible and that the patient will not be able

1-35     to become pregnant or bear children if she undergoes a

1-36     hysterectomy;

1-37                 (4)  a statement that the patient has the right to seek

1-38     a consultation from a second physician;

1-39                 (5)  a statement that the patient or person authorized

1-40     to consent for the patient has been informed that a hysterectomy is

1-41     a removal of the uterus through an incision in the lower abdomen or

1-42     vagina and that additional surgery may be necessary to remove or

1-43     repair other organs, including an ovary, tube, appendix, bladder,

1-44     rectum, or vagina;

1-45                 (6)  a description of the risks and hazards involved in

1-46     the performance of the procedure;

1-47                 (7)  a written statement to be signed by the patient or

1-48     person authorized to consent for the patient indicating that the

1-49     materials have been provided and explained to the patient or person

1-50     authorized to consent for the patient and that the patient or

1-51     person authorized to consent for the patient understands the nature

1-52     and consequences of a hysterectomy.

1-53           (d)  The physician or health care provider shall obtain

1-54     informed consent under this section and Section 6.05 of this Act

1-55     from the patient or person authorized to consent for the patient

1-56     before performing a hysterectomy unless the hysterectomy is

1-57     performed in a life-threatening situation in which the physician

1-58     determines obtaining informed consent is not reasonably possible.

1-59     If obtaining informed consent is not reasonably possible, the

1-60     physician or health care provider shall include in the patient's

1-61     medical records a written statement signed by the physician

1-62     certifying the nature of the emergency.

1-63           (e)  The panel may not prescribe materials under this section

1-64     without first consulting with the Texas State Board of Medical

 2-1     Examiners.

 2-2           SECTION 2.  (a)  This Act takes effect September 1, 1997.

 2-3           (b)  The Texas Medical Disclosure Panel shall prescribe the

 2-4     form and content of the materials required to be distributed under

 2-5     Section 6.08, Medical Liability and Insurance Improvement Act of

 2-6     Texas (Article 4590i, Vernon's Texas Civil Statutes), as added by

 2-7     this Act, not later than January 1, 1998.

 2-8           (c)  This Act applies only to a hysterectomy that is

 2-9     performed at least 90 days after the date that notice of the

2-10     adoption of the initial form and content of the materials required

2-11     to be distributed under Section 6.08, Medical Liability and

2-12     Insurance Improvement Act of Texas (Article 4590i, Vernon's Texas

2-13     Civil Statutes), as added by this Act, is published in the Texas

2-14     Register.

2-15           SECTION 3.  The importance of this legislation and the

2-16     crowded condition of the calendars in both houses create an

2-17     emergency and an imperative public necessity that the

2-18     constitutional rule requiring bills to be read on three several

2-19     days in each house be suspended, and this rule is hereby suspended.

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