1-1     By:  Barrientos                                       S.B. No. 1081

 1-2           (In the Senate - Filed March 10, 1997; March 12, 1997, read

 1-3     first time and referred to Committee on Jurisprudence;

 1-4     April 24, 1997, reported adversely, with favorable Committee

 1-5     Substitute by the following vote:  Yeas 6, Nays 1; April 24, 1997,

 1-6     sent to printer.)

 1-7     COMMITTEE SUBSTITUTE FOR S.B. No. 1081                    By:  Luna

 1-8                            A BILL TO BE ENTITLED

 1-9                                   AN ACT

1-10     relating to the regulation of the conduct of certain nurses.

1-11           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

1-12           SECTION 1.  Article 4525d, Revised Statutes, is amended by

1-13     amending Subsections (c) and (d) and by adding Subsection (e) to

1-14     read as follows:

1-15           (c)  If a person who regularly employs, hires, or otherwise

1-16     contracts for the services of at least 10 registered nurses

1-17     requests one of those registered nurses to engage in conduct that

1-18     the nurse believes violates a registered nurse's duty to a patient,

1-19     the nurse may request a finding by a nursing peer review committee

1-20     under Article 4525b, Revised Statutes, of whether the conduct

1-21     violates a registered nurse's duty to a patient.  A nurse who in

1-22     good faith requests, on a form produced by the board, a peer review

1-23     determination under this subsection may engage in the requested

1-24     conduct pending the peer review, is not subject to the reporting

1-25     requirement under Article 4525a, Revised Statutes, and may not be

1-26     disciplined by the board for engaging in that conduct while the

1-27     peer review is pending.  The findings of the peer review committee

1-28     shall be considered in a decision to discipline the nurse, but

1-29     those findings are not binding if a registered nurse administrator

1-30     believes in good faith that the peer review committee has

1-31     incorrectly determined a registered nurse's duty.  A nurse who in

1-32     good faith requests a peer review under this subsection may not be

1-33     disciplined or discriminated against for making the request.  If

1-34     the conduct for which the peer review is requested under this

1-35     subsection involves the medical reasonableness of a physician's

1-36     order, the medical staff or medical director shall be requested to

1-37     make a determination as to the medical reasonableness of the

1-38     physician's order, which shall be determinative of that issue.  A

1-39     registered nurse's rights under this article may not be nullified

1-40     by a contract.

1-41           (d)  An appropriate licensing agency may take action against

1-42     a person who violates this article.

1-43           (e) [(d)]  In this article:

1-44                 (1)  "Duty to a patient" means conduct, including

1-45     administrative decisions directly affecting a registered nurse's

1-46     ability to comply with that duty, required by standards of practice

1-47     or professional conduct adopted by the board.

1-48                 (2)  "Person" [, "person"] includes an individual,

1-49     organization, agency, facility, or other entity.

1-50           SECTION 2.  Subsection (a), Section 241.026, Health and

1-51     Safety Code, is amended to read as follows:

1-52           (a)  The board, with the advice of the council, shall adopt

1-53     and enforce rules to further the purposes of this chapter.  The

1-54     rules at a minimum shall address:

1-55                 (1)  minimum requirements for staffing by physicians

1-56     and nurses;

1-57                 (2)  hospital services relating to patient care;

1-58                 (3)  fire prevention, safety, and sanitation

1-59     requirements in hospitals;

1-60                 (4)  patient care and a patient bill of rights; [and]

1-61                 (5)  compliance with other state and federal laws

1-62     affecting the health, safety, and rights of hospital patients; and

1-63                 (6)  compliance with nursing peer review under Articles

1-64     4525a and 4525b, Revised Statutes, and the rules of the Board of

 2-1     Nurse Examiners relating to peer review.

 2-2           SECTION 3.  This Act takes effect September 1, 1997.

 2-3           SECTION 4.  The importance of this legislation and the

 2-4     crowded condition of the calendars in both houses create an

 2-5     emergency and an imperative public necessity that the

 2-6     constitutional rule requiring bills to be read on three several

 2-7     days in each house be suspended, and this rule is hereby suspended.

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