SRC-MKV C.S.S.B. 355 77(R)BILL ANALYSIS


Senate Research CenterC.S.S.B. 355
77R7891 JAT-DBy: Lindsay
Health & Human Services
3/30/2001
Committee Report (Substituted)


DIGEST AND PURPOSE 

Currently, the Texas Health and Safety Code contains provisions that govern
informed consent to psychiatric drugs for individuals in inpatient
psychiatric settings, but none that apply to the residents of nursing
homes.  C.S.S.B. 355 proposes to correct this inequity in the law by
extending the informed consent laws to residents of nursing homes. 

RULEMAKING AUTHORITY

This bill does not expressly grant any additional rulemaking authority to a
state officer, institution, or agency. 

SECTION BY SECTION ANALYSIS

SECTION 1.  Amends Section 242.501 (a), Health and Safety Code, to add
language regarding a nursing home's resident's statement of rights to
include the resident's right to have a physician explain to the resident
recommended treatments and expected results, including any expected
effects, clinically possible side effects, and risks associated with
psychoactive medications, and  to include the resident's right to receive
information about prescribed psychoactive medication from a treating
physician and pharmacist, to have any psychoactive medications prescribed
and administered in a responsible manner, as mandated by Section 242.505,
and to refuse to consent to the prescription of such drugs. 

SECTION 2.  Amends Chapter 242L, Health and Safety Code, by adding Section
242.505, as follows: 

Sec. 242.505.  PRESCRIPTION OF PSYCHOACTIVE MEDICATION.  (a) Defines
"medication-related emergency" and "psychoactive medication."   

(b) Prohibits a person from prescribing a psychoactive medication to a
resident who does not consent to the prescription unless the patient is
having a medication-related emergency or the person authorized by law to
consent on behalf of the resident has consented to the prescription. 

(c) Provides that consent to the prescription of psychoactive medication
given by a resident or by a person authorized by law to consent on behalf
of the resident is only valid under certain conditions. 

(d) Provides that if the treating physician designates another person to
provide the information under Subsection (c), not later than two working
days after that person provides the information, excluding weekends and
legal holidays, the physician is required to meet with the resident and, if
appropriate, the person authorized by law to consent on behalf of the
resident, to review the information and answer any questions. 

(e) Requires a resident's refusal to consent to receive psychoactive
medication to be documented in the resident's clinical record. 
 
(f) Requires a treating physician to prescribe, consistent with clinically
appropriate medical care, the medication that has the fewest side effects
or the least potential for adverse side effects, unless the class of
medication has been demonstrated or justified not to be effective
clinically, and administer the smallest therapeutically acceptable dosages
of medication for the resident's condition. 

(g) Provides that if a physician prescribed psychoactive medication without
the resident's consent because of a medication-related emergency, a
physician is required to document in the resident's clinical record in
specific terms the necessity of the order and that the physician has
evaluated but rejected other generally accepted, less intrusive forms of
treatment, if any, and requires the treatment to be provided in the manner,
consistent with clinically appropriate medical care, least restrictive of
the resident's personal liberty. 

SECTION 3.  Effective date: upon passage or September 1, 2001.


SUMMARY OF COMMITTEE CHANGES

Differs from original in SECTION 1 by changing references from
"administration of psychoactive medications" to "prescription of
psychoactive medications."  Further differs from original in SECTION 2 by
changing references from "the resident's representative authorized by law"
to "the person authorized by law."