SRC-JEC S.B. 876 77(R)   BILL ANALYSIS


Senate Research Center   S.B. 876
77R1481 JJT-DBy: Moncrief
Health & Human Services
3/20/2001
As Filed


DIGEST AND PURPOSE 

Currently, there are federal standards relating to emergency behavioral
interventions in psychiatric and medical facilities and psychiatric
residential treatment centers that receive Medicare and Medicaid.  As
proposed, S.B. 876 sets consistent standards for certain health care
facilities in the state in order to provide an equal level of patient
protection regardless of the setting, payment source, or characteristics of
the populations. 

RULEMAKING AUTHORITY

Rulemaking authority is expressly granted to a health and human services
agency that regulates the care or treatment of a resident in SECTION 1
(Section 322.003, Health and Safety Code) of this bill. 

SECTION BY SECTION ANALYSIS

SECTION 1.  Amends Title 4G, Health and Safety Code, by adding Chapter 322,
as follows: 

CHAPTER 322. USE OF RESTRAINT, SECLUSION, AND EMERGENCY PSYCHOACTIVE
MEDICATION IN CERTAIN HEALTH CARE FACILITIES 

SUBCHAPTER A.  GENERAL PROVISIONS

Sec. 322.001.  DEFINITIONS.  Defines "emergency," "emergency psychoactive
medication," "facility," "health and human services agency," "mechanical
restraint," "personal restraint," "physical redirection," "protective
device," "resident," "restraint," "seclusion," and "supportive device." 

Sec. 322.002.  APPLICABILITY.  Provides that this chapter applies to a
health and human services agency that regulates the care or treatment of a
resident. 

Sec. 322.003.  ADOPTION OF PROCEDURES.  Requires a health and human
services agency by rule to adopt procedures for the use on a resident of
mechanical restraint; personal restraint; seclusion; emergency psychoactive
medication; and supportive and protective devices.  Requires that the
procedures be consistent with this chapter and with the right of a resident
to be free from certain abusive behaviors. 

Sec. 322.004.  STAFF TRAINING.  Requires a facility to provide to its
staff, annually or more frequently if necessary, competency-based training
on:  procedures for managing a resident's behavior in an emergency; and the
prevention and de-escalation of a resident's aggressive behavior. 

Sec. 322.005.  REPORT OF DEATH OR INJURY DURING OR AFTER RESTRAINT,
SECLUSION, OR EMERGENCY PSYCHOACTIVE MEDICATION.  Requires a facility to
report to the appropriate law enforcement or regulatory agencies for
investigation a death of or serious injury to a resident if the death or
serious injury occurs during the use, or less than 48  hours after the
termination of the use, on the resident of restraint, seclusion, or
emergency psychoactive medication. 

Sec. 322.006.  REPORTS.  Requires a health and human services agency that
regulates a facility, each quarter, to collect information related to the
facility's use of emergency interventions.  Requires certain information to
be included.  Requires the agency, annually, to submit an analysis of the
information collected under this section to the governor and the presiding
officer of each house of the legislature. 

Sec. 322.007.  CERTAIN RESTRAINTS PROHIBITED.  Prohibits a person from
using certain restraints. 

Sec. 322.008.  NONEMERGENCY USE OF RESTRAINT OR SECLUSION. Authorizes
restraint to be used on a resident during medical, dental, or postsurgical
care, and seclusion to be used during medical care, if its use is necessary
and is a regular and customary part of the care. 
 
Sec. 322.009.  USE OF EMERGENCY PSYCHOACTIVE MEDICATION IN CONJUNCTION WITH
USE OF RESTRAINT OR SECLUSION.  Authorizes emergency psychoactive
medication to be administered to a resident at the time restraint or
seclusion is used on the resident only if clinically justified.  Requires
facility staff to document the specific behaviors that make the conjunctive
use of the different intervention methods necessary.  Sets forth
requirements for the use of emergency psychoactive medication on a resident
while restraint or seclusion is used on the resident. 
 
Sec. 322.010.  LIMITATION ON USE OF SECLUSION. Prohibits seclusion from
being used for a resident receiving care or treatment in certain
facilities. 
 
Sec. 322.011.  USE OF SUPPORTIVE OR PROTECTIVE DEVICE.  Prohibits a
supportive or protective device from being used as a substitute for
habilitative or rehabilitative care of a resident.  Sets forth reasons for
which a protective device may be used on a resident.  Sets forth
prohibitions regarding the use of a protective device.  Authorizes the use
of a supportive device to provide postural support for a resident to assist
the resident in obtaining or maintaining a normal bodily function.
Requires facility staff to periodically review the use of a supportive or
protective device on a resident and, where practicable, develop a plan to
overcome the need for the device. 

[Reserves Sections 322.012-322.020 for expansion.]

SUBCHAPTER B.  USE OF RESTRAINT, SECLUSION, OR EMERGENCY
PSYCHOACTIVE MEDICATION IN CERTAIN FACILITIES FOR CHILDREN
 
Sec. 322.021.  APPLICABILITY. Provides that this subchapter applies only to
a child-care institution, as defined by Section 42.002 (Definitions), Human
Resources Code, that is licensed by the Department of Protective and
Regulatory Services as a residential treatment center or an institution
serving children with mental retardation. 

Sec. 322.022.  RESTRAINT, SECLUSION, OR EMERGENCY PSYCHOACTIVE MEDICATION
AS RESPONSE TO EMERGENCY.  Authorizes  the use, except as provided by
Section 322.008, of restraint, seclusion, or emergency psychoactive
medication on a resident only in an emergency.  Prohibits seclusion from
being used on a resident with mental retardation. 
 
Sec. 322.023.  INITIATION OF AND PHYSICIAN'S ORDER FOR USE OF RESTRAINT,
SECLUSION, OR EMERGENCY PSYCHOACTIVE MEDICATION.  Authorizes the initiation
of the use of restraint, seclusion, or emergency psychoactive medication
only by a member of a facility's staff who has completed competency-based
training in the use of behavioral interventions and de-escalation
techniques.  Authorizes the procession of the use of a mechanical
restraint, seclusion, or emergency psychoactive medication only under a
physician's written order.  Requires a physician to issue the order not
more than one hour after the use of the restraint, seclusion, or medication
is initiated.  Prohibits a physician from authorizing the use of a
mechanical restraint or seclusion by a pro re nata (PRN) order. 
 
Sec. 322.024.  CONSIDERATIONS BEFORE ISSUANCE OF ORDER.  Requires a
physician, in determining whether to order or continue the use of a
mechanical restraint, seclusion, or emergency psychoactive medication, to
consider medical and psychiatric contraindications, including a resident's
history regarding physical or sexual abuse or substance abuse. 
 
Sec. 322.025.  DOCUMENTATION SUPPORTING USE.  Requires a facility that uses
restraint, seclusion, or emergency psychoactive medication to document
certain information.  Requires the member of the staff who initiates the
use of restraint, seclusion, or emergency psychoactive medication to sign
the document. 
 
Sec. 322.026.  CONSULTATION REGARDING ALTERNATIVE TREATMENT STRATEGIES.
Requires staff members who are treating a resident, if any combination of
restraint, seclusion, or emergency psychoactive medication is used on the
resident three or more times in a 30-day period, to consult with a
clinician who is not treating the resident to explore alternative treatment
strategies. 
 
Sec. 322.027.  LIMITATION ON USE OF MECHANICAL RESTRAINT.  Authorizes
mechanical restraint to be used only on a resident receiving care or
treatment in a facility that: serves persons with mental retardation
exclusively; or is a residential treatment facility licensed by the
Department of Protective and Regulatory Services. 
 
Sec. 322.028.  PHYSICIAN'S ORDER FOR USE OF MECHANICAL RESTRAINT. Requires
a physician's order for the use of a mechanical restraint to specify:  the
maximum duration of the use of the restraint; the date and time of its use;
and specific behaviors for release. 
 
Sec. 322.029.  DURATION OF USE OF MECHANICAL RESTRAINT.  Requires the use
of a mechanical restraint on a resident to end at the earliest possible
time.  Except as provided by this section, prohibits a mechanical restraint
from being used on a resident for longer than: 
  
  (1)  30 minutes for a resident younger than nine years of age;
(2)  one hour for a resident at least nine years of age but younger than 18
years of age; or 
  (3)  two hours for a resident 18 years of age or older.

Prohibits the use of a mechanical restraint from proceeding beyond the time
provided by the original order unless its use is authorized by a physician
after the physician conducts an in-person evaluation.  Prohibits a
mechanical restraint from being used continuously under the original order
and one or more continuations of the order for longer than a total of 12
hours. 
 
Sec. 322.030.  MONITORING RESIDENT UNDER MECHANICAL RESTRAINT.  Requires
facility staff, while a mechanical restraint is used on a resident, to:
observe the resident continuously; provide the resident with the
opportunity to drink water and use a toilet every two hours and more
frequently if needed; and monitor the resident's circulation, skin color,
respiration, and range of motion. 
 
 Sec. 322.031.  USE OF PERSONAL RESTRAINT.  Requires the use of personal
restraint on a resident to end at the earliest possible time.  Requires
facility staff to continuously observe a resident under personal restraint
and monitor the resident's breathing. 
 
Sec. 322.032.  SAFE AND OBSERVABLE AREA FOR SECLUSION.  Requires an area
used for seclusion to:  be free of hazards that may cause physical injury
to a resident; and permit the direct observation of a resident in the area. 

Sec. 322.033.  DURATION OF SECLUSION.  Requires the seclusion of a resident
to end at the earliest possible time. 

Sec. 322.034.  OPPORTUNITY FOR WATER AND TOILET.  Requires facility staff
to provide a resident under seclusion with the opportunity to drink water
and use a toilet every two hours and more frequently if needed. 

[Reserves Sections 322.035-322.080 for expansion.]

SUBCHAPTER C.  USE OF RESTRAINT, SECLUSION, OR EMERGENCY
PSYCHOACTIVE MEDICATION IN INTERMEDIATE CARE FACILITY
 
Sec. 322.081.  APPLICABILITY.  Provides that this subchapter applies only
to an intermediate care facility licensed by the Texas Department of Human
Services under Chapter 252 or operated by the Texas Department of Human
Services or the Texas Department of Mental Health and Mental Retardation
and exempt under Section 252.003 from the licensing requirements of that
chapter. 
 
 Sec. 322.082.  DEFINITION. Defines "exclusionary time-out."
 
Sec. 322.083.  SECLUSION PROHIBITED.  Prohibits seclusion from being used
on a resident of an intermediate care facility. 
 
Sec. 322.084.  USE OF EXCLUSIONARY TIME-OUT.  Authorizes an exclusionary
time-out to be used only in accordance with applicable federal law and for
a period not to exceed one hour. Prohibits a person from placing a resident
alone in a locked room as part of an exclusionary time-out. 
 
Sec. 322.085.  INITIATION OF AND PHYSICIAN'S ORDER FOR USE OF RESTRAINT,
TIME-OUT, OR EMERGENCY PSYCHOACTIVE MEDICATION. Authorizes the initiation
of restraint, exclusionary time-out, or emergency psychoactive medication
only by a member of a facility's staff who has completed competency-based
training in the use of behavioral interventions and de-escalation
techniques.  Authorizes the procession of the use of restraint or emergency
psychoactive medication only under a physician's order. Authorizes the
procession of the use of exclusionary time-out only under a physician's
order or as specified in the resident's behavior plan.  Requires a
physician to issue the order not more than one hour after the use of the
restraint, exclusionary time-out, or emergency psychoactive medication is
initiated.  Prohibits a physician from authorizing the use of restraint or
emergency psychoactive medication by a pro re nata (PRN) order. 
 
Sec. 322.086.  CONSIDERATIONS BEFORE ISSUANCE OF ORDER.  Makes conforming
changes. 
 
Sec. 322.087.  DOCUMENTATION SUPPORTING USE.  Provides the documentation
requirement under this section does not apply when the use of exclusionary
time-out is as provided in the resident's behavior plan.  Makes conforming
changes. 
 
 Sec. 322.088.  CONSULTATION REGARDING ALTERNATIVE TREATMENT STRATEGIES.
Makes conforming changes. 
 
Sec. 322.089.  PHYSICIAN'S ORDER FOR USE OF MECHANICAL RESTRAINT. Makes a
conforming change. 
 
Sec. 322.090.  DURATION OF USE OF MECHANICAL RESTRAINT.  Prohibits, except
as provided by this section, a mechanical restraint from being used on a
resident for longer than: 
  
   (1)  30 minutes for a resident younger than nine years of age;
   (2)  one hour for a resident who is:
    (A)  at least 9 years of age but younger than 18 years of age; or
    (B)  65 years of age or older; or
(3)  two hours for a resident 18 years of age or older but younger than 65
years of age. 
 
Makes conforming changes.
 
Sec. 322.091.  MONITORING RESIDENT UNDER MECHANICAL RESTRAINT. Makes
conforming changes. 

Sec. 322.092.  USE OF PERSONAL RESTRAINT. Makes conforming changes.

[Reserves Sections 322.093-322.130 for expansion.]

SUBCHAPTER D.  USE OF RESTRAINT, SECLUSION, OR EMERGENCY
PSYCHOACTIVE MEDICATION IN MENTAL HOSPITAL OR
MENTAL HEALTH FACILITY
 
Sec. 322.131.  APPLICABILITY.  Provides that this subchapter applies only
to a mental hospital or mental health facility, as defined by Section
571.003. 
 
Sec. 322.132.  RESTRAINT, SECLUSION, OR EMERGENCY PSYCHOACTIVE MEDICATION
AS RESPONSE TO EMERGENCY.  Authorizes the use on a resident of restraint,
seclusion, or emergency psychoactive medication only in an emergency,
except as provided by Section 322.008. 
 
Sec. 322.133.  INITIATION OF AND PHYSICIAN'S ORDER FOR USE OF RESTRAINT,
SECLUSION, OR EMERGENCY PSYCHOACTIVE MEDICATION. Sets forth conforming
guidelines for the use of restraint, seclusion, or emergency psychoactive
medication. 
 
Sec. 322.134.  CONSIDERATIONS BEFORE ISSUANCE OF ORDER.  Makes conforming
changes. 
 
 Sec. 322.135.  DOCUMENTATION SUPPORTING USE.  Makes conforming changes.

Sec. 322.136.  CONSULTATION REGARDING ALTERNATIVE TREATMENT STRATEGIES.
Makes conforming changes. 

Sec. 322.137.  PHYSICIAN'S ORDER FOR USE OF MECHANICAL RESTRAINT. Requires
a physician's order for the use of a mechanical restraint to specify:  the
maximum duration of the use of the restraint; the date and time of its use;
and specific behaviors for release. 
 
 Sec. 322.138.  DURATION OF USE OF MECHANICAL RESTRAINT. Makes conforming
changes. 

Sec. 322.139.  MONITORING OF RESIDENT UNDER MECHANICAL RESTRAINT. Makes
conforming changes. 
 
 Sec. 322.140.  USE OF PERSONAL RESTRAINT.  Makes conforming changes.
 
Sec. 322.141.  SAFE AND OBSERVABLE AREA FOR SECLUSION.  Makes conforming
changes. 

 Sec. 322.142.  DURATION OF SECLUSION.  Makes conforming changes.
 
Sec. 322.143.  OPPORTUNITY FOR WATER AND TOILET.  Makes conforming changes.

[Reserves Sections 322.144-322.180 for expansion.]

SUBCHAPTER E.  USE OF RESTRAINT, SECLUSION, OR EMERGENCY
PSYCHOACTIVE MEDICATION IN NURSING FACILITY
 
Sec. 322.181.  APPLICABILITY.  Provides that this subchapter applies only
to a nursing facility, as defined by Section 242.301. 
 
Sec. 322.182.  SECLUSION PROHIBITED.  Prohibits seclusion from being used
on a resident of a nursing facility. 

Sec. 322.183.  RESTRAINT OR EMERGENCY PSYCHOACTIVE MEDICATION AS RESPONSE
TO EMERGENCY. Authorizes the use on a resident of restraint or emergency
psychoactive medication only in an emergency, except as provided by Section
322.008. 

Sec. 322.184.  INITIATION OF AND PHYSICIAN'S ORDER FOR USE OF RESTRAINT OR
EMERGENCY PSYCHOACTIVE MEDICATION.  Makes conforming changes. 

Sec. 322.185.  CONSIDERATIONS BEFORE ISSUANCE OF ORDER.  Makes conforming
changes. 

 Sec. 322.186.  DOCUMENTATION SUPPORTING USE.  Makes conforming changes.

Sec. 322.187.  CONSULTATION REGARDING ALTERNATIVE TREATMENT STRATEGIES.
Makes conforming changes. 

Sec. 322.188.  PHYSICIAN'S ORDER FOR USE OF MECHANICAL RESTRAINT.  Makes
conforming changes. 

Sec. 322.189.  DURATION OF USE OF MECHANICAL RESTRAINT.  Makes conforming
changes. 

Sec. 322.190.  MONITORING RESIDENT UNDER MECHANICAL RESTRAINT.  Makes
conforming changes. 

 Sec. 322.191.  USE OF PERSONAL RESTRAINT.  Makes conforming changes.

[Reserves Sections 322.192-322.220 for expansion.]

 SUBCHAPTER F.  USE OF RESTRAINT, SECLUSION, OR EMERGENCY
PSYCHOACTIVE MEDICATION IN ASSISTED LIVING FACILITY

Sec. 322.221.  APPLICABILITY.  Provides that this subchapter applies only
to an assisted living facility, as defined by Section 247.002. 

Sec. 322.222.  USE OF MECHANICAL RESTRAINT, PSYCHOACTIVE MEDICATION, OR
SECLUSION PROHIBITED.  Prohibits a mechanical restraint, emergency
psychoactive medication, or seclusion from being used on a resident
receiving care or treatment in an assisted living facility. 

 Sec. 322.223.  USE OF PERSONAL RESTRAINT.  Makes conforming changes.

SECTION 2.  Requires a health and human services agency described by
Section 322.002, Health and Safety Code, as added by this Act, to adopt
rules as necessary to implement Chapter 322, Health and Safety Code, as
added by this Act, not later than January 1, 2002. 
 
SECTION 3. Effective date:  September 1, 2001, except that SECTION 1 takes
effect January 1, 2002.