By Najera H.B. No. 3424
Line and page numbers may not match official copy.
Bill not drafted by TLC or Senate E&E.
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the regulation of the use of restraints, seclusion and
1-3 emergency medication in psychiatric hospitals and other entities
1-4 providing long term care services.
1-5 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-6 Section 1. Subtitle C, Title 7, Health and Safety Code, is
1-7 amended by adding Chapter 579 to read as follows:
1-8 Chapter 579. USE OF RESTRAINT, SECLUSION AND EMERGENCY
1-9 MEDICATION IN PSYCHIATRIC HOSPITALS AND LONG TERM CARE FACILITIES.
1-10 Sec. 579.001. DEFINITIONS. In this chapter:
1-11 (1) "Chemical restraint" means the use of any
1-12 chemical, including pharmaceuticals, through topical application,
1-13 oral administration, injection, or other means for purposes of
1-14 restraining an individual.
1-15 (2) "Emergency" means situations in which it is
1-16 immediately necessary to restrain or seclude a person to prevent
1-17 imminent probable death or substantial bodily harm to the person
1-18 because the person overtly or continually is threatening or
1-19 attempting to commit suicide or serious bodily harm or imminent
1-20 physical harm to others because of threats, attempts or other acts
1-21 the person overtly or continually makes or commits and preventive
2-1 de-escalative, or verbal techniques have proven ineffective at
2-2 diffusing the potential for injury.
2-3 (3) "Mechanical restraint" means the use of a
2-4 mechanical device to involuntarily restrict the free movement of
2-5 the whole or a portion of an individual's body in order to control
2-6 physical activity.
2-7 (4) "Seclusion" means the placement of an individual
2-8 alone for any period of time in a hazard-free room or any other
2-9 area in which direct observation can be maintained and from which
2-10 egress is prevented.
2-11 (5) "Supportive devices" means restraints used to
2-12 postural support an individual or to assist individuals who cannot
2-13 obtain and or maintain normal bodily functioning.
2-14 (6) "Physical restraint" means the application of
2-15 physical force alone restricting the free movement of the whole or
2-16 a significant portion of an individual's body in order to control
2-17 physical activity.
2-18 (7) "PRN" means an as needed order by a physician.
2-19 (8) "Protective devices" means restraints used to
2-20 prevent involuntary self injury or to permit wounds to heal.
2-21 Sec. 579.002. IN GENERAL. (a) An entity which regulates
2-22 the care and treatment in nursing homes, hospitals (public and
2-23 private), intermediate care facilities, personal care facilities,
2-24 residential treatment centers, foster care facilities shall
2-25 promulgate rules under which physical restraint, mechanical
3-1 restraint, seclusion, emergency medication, supportive devices or
3-2 protective devices can be used, which are consistent with, but not
3-3 limited to:
3-4 (1). protecting and promoting the right of the
3-5 individual to be free from physical or mental abuse; free from
3-6 corporal punishment; free from restraints which are imposed for the
3-7 purposes of punishment, as a substitute for effective treatment or
3-8 habilitation, for the convenience of staff or due to the lack of
3-9 adequate staff; and
3-10 (2) chemical restraint is not a recognized form of
3-11 patient management in the State of Texas and is prohibited. This
3-12 includes, but is not limited to, chemical sprays that are intended
3-13 to temporal restrain an individual, including tear gas and pepper
3-14 spray; and
3-15 (3) the application of a mechanical restraint,
3-16 seclusion or administration of emergency medications is prohibited
3-17 in personal care facilities; and
3-18 (4) at least annually training shall be provided to
3-19 staff on preventive techniques and management of aggressive
3-20 behaviors.
3-21 Sec. 579.003. IMPLEMENTATION. (a) Seclusion, physical
3-22 restraint or mechanical restraints may only be used as a last
3-23 resort and only after other less restrictive alternative strategies
3-24 have failed e.g. preventive, de-escalative techniques and verbal
3-25 interventions.
4-1 (b) In making the determination that a mechanical restraint,
4-2 seclusion or emergency medication, consideration shall be
4-3 administered, consideration must be given to:
4-4 (1) medical contraindications; and
4-5 (2) psychiatric contraindications, including history
4-6 of:
4-7 (A) sexual abuse; or
4-8 (B) substance abuse.
4-9 (c) Physical restraints, mechanical restraints, seclusion or
4-10 emergency medications may only be imposed in situation which meets
4-11 the definition of emergency.
4-12 (d) Documentation must specify the specific behaviors which
4-13 constituted the emergency, the alternatives attempted, and the
4-14 individuals response to the alternative attempted.
4-15 (e) When a physical restraint, mechanical restraint or
4-16 seclusion is appropriate it must be removed or ended at the
4-17 earliest possible time.
4-18 (f) Only upon an order by a physician shall an emergency
4-19 medication, mechanical restraint, or seclusion be applied, and
4-20 only if:
4-21 (1) orders for the duration of mechanical restraints
4-22 specify:
4-23 (A) the date; and
4-24 (B) time of day; and
4-25 (C) maximum length of time.
5-1 (2) the maximum length of time for a mechanical
5-2 restraint shall not exceed four hours for adults, two hours for
5-3 adolescents and children ages 9-17, and one hour for children under
5-4 the age of 9 for which the procedure may be used unless
5-5 continuation is authorized based on a face to face evaluation by a
5-6 medical physician or registered nurse; and
5-7 (3) if the order can be continued, the maximum
5-8 duration for renewal cannot exceed 12 hours including the original
5-9 order; and
5-10 (4) PRN orders for mechanical restraints or seclusion
5-11 shall be prohibited; and
5-12 (5) PRN orders for emergency medications are
5-13 prohibited with the exception of foster care facilities.
5-14 (g) Water and bathroom privileges must be offered at least
5-15 every two hours during seclusion or during the application of a
5-16 mechanical restraint.
5-17 (h) Vital signs must be taken every fifteen minutes through
5-18 the duration of a mechanical restraint.
5-19 (i) Continuous observation must occur of individuals placed
5-20 in a physical or mechanical restraint, including monitoring of
5-21 breathing.
5-22 (j) Continuous observation must occur of individuals placed
5-23 in seclusion who have also been administered emergency medication.
5-24 (k) A consultation with a clinician not part of the
5-25 treatment team must occur when a mechanical restraint, seclusion or
6-1 emergency medication is administered more than twice within a
6-2 thirty day period, to explore alternative treatment strategies.
6-3 (l) The concurrent use of emergency medication with
6-4 seclusion or mechanical restraint must be clinically justified and
6-5 documented.
6-6 (m) Mechanical restraint or seclusion may be used during
6-7 medical or dental care or rehabilitation if necessary and a regular
6-8 and customary part of care or rehabilitation treatment.
6-9 (n) Every death or serious physical injury, as defined in
6-10 the state penal code, which happens during or within 48 hours
6-11 subsequent to a physical restraint, mechanical restraint or
6-12 seclusion must be reported to law enforcement and to the
6-13 appropriate regulatory agency for investigation.
6-14 (o) The entity shall file incident reports as required under
6-15 section (579.006).
6-16 Sec. 579.004. USE OF SUPPORTIVE DEVICES. (a) The use of
6-17 supportive devices are considered an adjunct to proper care of an
6-18 individual but must be reviewed by the treatment team and a plan
6-19 developed to identify and overcome the need for the protective
6-20 device.
6-21 (b) Supportive devices may not be used as a substitute for
6-22 appropriate nursing rehabilitative or habilitative care.
6-23 Sec. 579.005. USE OF PROTECTIVE DEVICES. (a) The use of
6-24 protective devices may be used to prevent self injury but must be
6-25 reviewed by the treatment team and a plan developed to identify and
7-1 overcome the need for the protective device.
7-2 (b) Protective devices may not be used as a substitute for
7-3 appropriate nursing rehabilitative or habilitative care.
7-4 Sec. 579.006. REPORTS. (a) Data relating to the
7-5 administration of mechanical restraints, seclusion and emergency
7-6 medication shall be collected by each regulating agency on a
7-7 quarterly and annual basis to be analyzed, with summary reports
7-8 submitted to the governor and the presiding officer of each house
7-9 of the legislature. The data shall include:
7-10 (1) the number of patients who received mechanical
7-11 restraints, seclusion or emergency medication; and
7-12 (2) the age, sex and race of the persons receiving the
7-13 mechanical restraint, seclusion or emergency medication; and
7-14 (3) any serious physical injuries or deaths which
7-15 occurred during or within 48 hours of the physical restraint,
7-16 mechanical restraint, seclusion or emergency medication; and
7-17 (4) autopsy findings if death followed within 14 days
7-18 after the date of the administration of the physical restraint,
7-19 mechanical restraint, seclusion or emergency medication; and
7-20 (5) the funding source for the individual.
7-21 SECTION 2. This Act takes effect September 1, 1999.
7-22 SECTION 3. The importance of this legislation and the
7-23 crowded condition of the calendars in both houses create an
7-24 emergency and an imperative public necessity that the
7-25 constitutional rule requiring bills to be read on three several
8-1 days in each house by suspended, and this rule is hereby suspended.