By: Patterson S.B. No. 1309
97S0789/1
A BILL TO BE ENTITLED
AN ACT
1-1 relating to the regulation of the use of electroconvulsive therapy.
1-2 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-3 SECTION 1. Sections 578.001, 578.002, and 578.003, Health
1-4 and Safety Code, are amended to read as follows:
1-5 Sec. 578.001. APPLICATION. (a) This chapter applies to the
1-6 use of electroconvulsive therapy, psychosurgery, pre-frontal sonic
1-7 sound treatment, or any other convulsive or coma-inducing therapy
1-8 by any person, including a private physician who uses the therapy
1-9 on an outpatient basis.
1-10 (b) In this chapter, "electroconvulsive therapy" means a
1-11 somatic treatment for a psychiatric illness in which an electrical
1-12 current is administered to the brain and causes a seizure.
1-13 Sec. 578.002. USE OF ELECTROCONVULSIVE THERAPY.
1-14 (a) Electroconvulsive therapy may not be used on a person who is
1-15 younger than 16 years of age.
1-16 (b) Electroconvulsive therapy may not be used on a person
1-17 who is 65 years of age or older.
1-18 (c) Unless the person consents to the use of the therapy in
1-19 accordance with Section 578.003, electroconvulsive therapy may not
1-20 be used on:
1-21 (1) a person who is 16 years of age or older but who
1-22 is younger than 65 years of age and who is voluntarily receiving
1-23 mental health services; or
2-1 (2) an involuntary patient who is 16 years of age or
2-2 older but who is younger than 65 years of age and who has not been
2-3 adjudicated by an appropriate court of law as incompetent to manage
2-4 the patient's personal affairs.
2-5 (d) [(c)] Electroconvulsive therapy may not be used on an
2-6 involuntary patient who is 16 years of age or older and who has
2-7 been adjudicated incompetent to manage the patient's personal
2-8 affairs unless the patient's guardian of the person consents to the
2-9 treatment in accordance with Section 578.003. The decision of the
2-10 guardian must be based on knowledge of what the patient would
2-11 desire, if known.
2-12 Sec. 578.003. CONSENT TO THERAPY. (a) The department
2-13 [board] by rule shall adopt a standard written consent form to be
2-14 used when electroconvulsive therapy is considered. The department
2-15 [board] by rule shall also prescribe the information that must be
2-16 contained in the written supplement required under Subsection (c).
2-17 In addition to the information required under this section, the
2-18 form must include the information required by the Texas Medical
2-19 Disclosure Panel for electroconvulsive therapy. In developing the
2-20 form, the department [board] shall consider recommendations of the
2-21 panel. Use of the consent form prescribed by the department
2-22 [board] in the manner prescribed by this section creates a
2-23 rebuttable presumption that the disclosure requirements of Sections
2-24 6.05 and 6.06, Medical Liability and Insurance Improvement Act of
2-25 Texas (Article 4590i, Vernon's Texas Civil Statutes), have been
3-1 met.
3-2 (b) The written consent form must clearly and explicitly
3-3 state:
3-4 (1) the nature and purpose of the procedure;
3-5 (2) the nature, degree, duration, and probability of
3-6 the side effects and significant risks of the treatment commonly
3-7 known by the medical profession, especially noting the possible
3-8 degree and duration of memory loss, the possibility of permanent
3-9 irrevocable memory loss, and the [remote] possibility of death;
3-10 (3) that autopsies are required after all deaths
3-11 following procedures listed in Section 578.001(a) when death occurs
3-12 within 14 days after a procedure and state that consent for these
3-13 procedures includes consent for an autopsy within that time period;
3-14 (4) that there is a division of opinion as to the
3-15 efficacy of the procedure; and
3-16 (5) [(4)] the probable degree and duration of
3-17 improvement or remission expected with or without the procedure.
3-18 (c) Before a patient receives each electroconvulsive
3-19 treatment, the hospital, facility, or physician administering the
3-20 therapy shall ensure that:
3-21 (1) the patient and the patient's guardian of the
3-22 person, if any, receives a written copy of the consent form that is
3-23 in the person's primary language, if possible;
3-24 (2) the patient and the patient's guardian of the
3-25 person, if any, receives a written supplement that contains related
4-1 information that pertains to the particular patient being treated;
4-2 (3) the contents of the consent form and the written
4-3 supplement are explained to the patient and the patient's guardian
4-4 of the person, if any:
4-5 (A) orally, in simple, nontechnical terms in the
4-6 person's primary language, if possible; or
4-7 (B) through the use of a means reasonably
4-8 calculated to communicate with a hearing impaired or visually
4-9 impaired person, if applicable;
4-10 (4) if multiple monitored electroconvulsive therapy is
4-11 to be used, the patient or the patient's guardian of the person has
4-12 gained the agreement of two other concurring psychiatrists that the
4-13 procedure is vital and necessary and has obtained the dated
4-14 signatures of those psychiatrists at the bottom of the consent
4-15 form;
4-16 (5) the patient or the patient's guardian of the
4-17 person has received the opinion of a nonsurgical, nonpsychiatric
4-18 doctor who is not involved in the administration of
4-19 electroconvulsive therapy that the procedure will not cause
4-20 significant injury or death to the patient;
4-21 (6) the patient or the patient's guardian of the
4-22 person, as appropriate, signs a copy of the consent form stating
4-23 that the person has read the consent form and the written
4-24 supplement and understands the information included in the
4-25 documents; and
5-1 (7) [(5)] the signed copy of the consent form is made
5-2 a part of the patient's clinical record.
5-3 (d) Consent given under this section is not valid unless the
5-4 person giving the consent understands the information presented and
5-5 consents voluntarily and without coercion or undue influence.
5-6 SECTION 2. Subsection (b), Section 578.007, Health and
5-7 Safety Code, is amended to read as follows:
5-8 (b) A report must state for each quarter:
5-9 (1) the number of patients who received the therapy,
5-10 including:
5-11 (A) the number of persons voluntarily receiving
5-12 mental health services who consented to the therapy;
5-13 (B) the number of involuntary patients who
5-14 consented to the therapy; and
5-15 (C) the number of involuntary patients for whom
5-16 a guardian of the person consented to the therapy;
5-17 (2) the age, sex, and race of the persons receiving
5-18 the therapy;
5-19 (3) the source of the treatment payment;
5-20 (4) the average number of nonelectroconvulsive
5-21 treatments;
5-22 (5) the average number of electroconvulsive treatments
5-23 administered for each complete series of treatments, but not
5-24 including maintenance treatments;
5-25 (6) the average number of maintenance
6-1 electroconvulsive treatments administered per month;
6-2 (7) the number of fractures, reported memory losses,
6-3 incidents of apnea, and cardiac arrests without death;
6-4 (8) the number of deaths following electroconvulsive
6-5 therapy, or other therapies listed in Section 578.001(a), at 14
6-6 days, one month, and three months;
6-7 (9) autopsy findings, with emphasis on brain tissue,
6-8 if death followed within 14 days after the date of the
6-9 administration of any of the procedures listed in Section
6-10 578.001(a) [therapy]; and
6-11 (10) [(9)] any other information required by the
6-12 department.
6-13 SECTION 3. This Act takes effect September 1, 1997.
6-14 SECTION 4. The importance of this legislation and the
6-15 crowded condition of the calendars in both houses create an
6-16 emergency and an imperative public necessity that the
6-17 constitutional rule requiring bills to be read on three several
6-18 days in each house be suspended, and this rule is hereby suspended.