75R11886 GJH-F                           

         By Maxey                                              H.B. No. 1433

         Substitute the following for H.B. No. 1433:

         By Berlanga                                       C.S.H.B. No. 1433

                                A BILL TO BE ENTITLED

 1-1                                   AN ACT

 1-2     relating to the regulation of the conduct of certain nurses.

 1-3           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

 1-4           SECTION 1.  Article 4525d, Revised Statutes, is amended by

 1-5     amending Subsections (c) and (d) and by adding Subsection (e) to

 1-6     read as follows:

 1-7           (c)  If a person who regularly employs, hires, or otherwise

 1-8     contracts for the services of at least 10 registered nurses

 1-9     requests one of those registered nurses to engage in conduct that

1-10     the nurse believes violates a registered nurse's duty to a patient,

1-11     the nurse may request a finding by a nursing peer review committee

1-12     under Article 4525b, Revised Statutes, of whether the conduct

1-13     violates a registered nurse's duty to a patient.  A nurse who in

1-14     good faith requests, on a form produced by the board, a peer review

1-15     determination under this subsection may engage in the requested

1-16     conduct pending the peer review, is not  subject to the reporting

1-17     requirement under Article 4525a, Revised Statutes, and may not be

1-18     disciplined by the board for engaging in that conduct while the

1-19     peer review is pending.  The findings of the peer review committee

1-20     shall be considered in a decision to discipline the nurse, but

1-21     those findings are not binding if a registered nurse administrator

1-22     believes in good faith that the peer review committee has

1-23     incorrectly determined a registered nurse's duty.  A nurse who in

1-24     good faith requests a peer review under this subsection may not be

 2-1     disciplined or discriminated against for making the request.  If

 2-2     the conduct for which the peer review is requested under this

 2-3     subsection involves the medical reasonableness of a physician's

 2-4     order, the medical staff or medical director shall be requested to

 2-5     make a determination as to the medical reasonableness of the

 2-6     physician's order, which shall be determinative of that issue.  A

 2-7     registered nurse's rights under this article may not be nullified

 2-8     by a contract.

 2-9           (d)  An appropriate licensing agency may take action against

2-10     a person who violates this article.

2-11           (e) [(d)]  In this article: [,]

2-12                 (1)  "Duty to a patient" means conduct, including

2-13     administrative decisions directly affecting a registered nurse's

2-14     ability to comply with that duty, required by standards of practice

2-15     or professional conduct adopted by the board.

2-16                 (2)  "Person" ["person"] includes an individual,

2-17     organization, agency, facility, or other entity.

2-18           SECTION 2.  Section 241.026(a), Health and Safety Code, is

2-19     amended to read as follows:

2-20           (a)  The board, with the advice of the council, shall adopt

2-21     and enforce rules to further the purposes of this chapter.  The

2-22     rules at a minimum shall address:

2-23                 (1)  minimum requirements for staffing by physicians

2-24     and nurses;

2-25                 (2)  hospital services relating to patient care;

2-26                 (3)  fire prevention, safety, and sanitation

2-27     requirements in hospitals;

 3-1                 (4)  patient care and a patient bill of rights; [and]

 3-2                 (5)  compliance with other state and federal laws

 3-3     affecting the health, safety, and rights of hospital patients; and

 3-4                 (6)  compliance with nursing peer review under Articles

 3-5     4525a and 4525b, Revised Statutes, and the rules of the Board of

 3-6     Nurse Examiners relating to peer review.

 3-7           SECTION 3.  This Act takes effect September 1, 1997.

 3-8           SECTION 4.  The importance of this legislation and the

 3-9     crowded condition of the calendars in both houses create an

3-10     emergency and an imperative public necessity that the

3-11     constitutional rule requiring bills to be read on three several

3-12     days in each house be suspended, and this rule is hereby suspended.