1-1 AN ACT
1-2 relating to a nursing home resident's right to informed consent
1-3 regarding the prescription of certain drugs.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Subsection (a), Section 242.501, Health and
1-6 Safety Code, is amended to read as follows:
1-7 (a) The department by rule shall adopt a statement of the
1-8 rights of a resident. The statement must be consistent with
1-9 Chapter 102, Human Resources Code, but shall reflect the unique
1-10 circumstances of a resident at an institution. At a minimum, the
1-11 statement of the rights of a resident must address the resident's
1-12 constitutional, civil, and legal rights and the resident's right:
1-13 (1) to be free from abuse and exploitation;
1-14 (2) to safe, decent, and clean conditions;
1-15 (3) to be treated with courtesy, consideration, and
1-16 respect;
1-17 (4) to not be subjected to discrimination based on
1-18 age, race, religion, sex, nationality, or disability and to
1-19 practice the resident's own religious beliefs;
1-20 (5) to privacy, including privacy during visits and
1-21 telephone calls;
1-22 (6) to complain about the institution and to organize
1-23 or participate in any program that presents residents' concerns to
1-24 the administrator of the institution;
1-25 (7) to have information about the resident in the
2-1 possession of the institution maintained as confidential;
2-2 (8) to retain the services of a physician the resident
2-3 chooses, at the resident's own expense or through a health care
2-4 plan, and to have a physician explain to the resident, in language
2-5 that the resident understands, the resident's complete medical
2-6 condition, the recommended treatment, and the expected results of
2-7 the treatment, including reasonably expected effects, side effects,
2-8 and risks associated with psychoactive medications;
2-9 (9) to participate in developing a plan of care, to
2-10 refuse treatment, and to refuse to participate in experimental
2-11 research;
2-12 (10) to a written statement or admission agreement
2-13 describing the services provided by the institution and the related
2-14 charges;
2-15 (11) to manage the resident's own finances or to
2-16 delegate that responsibility to another person;
2-17 (12) to access money and property that the resident
2-18 has deposited with the institution and to an accounting of the
2-19 resident's money and property that are deposited with the
2-20 institution and of all financial transactions made with or on
2-21 behalf of the resident;
2-22 (13) to keep and use personal property, secure from
2-23 theft or loss;
2-24 (14) to not be relocated within the institution,
2-25 except in accordance with standards adopted by the department under
2-26 Section 242.403;
3-1 (15) to receive visitors;
3-2 (16) to receive unopened mail and to receive
3-3 assistance in reading or writing correspondence;
3-4 (17) to participate in activities inside and outside
3-5 the institution;
3-6 (18) to wear the resident's own clothes;
3-7 (19) to discharge himself or herself from the
3-8 institution unless the resident is an adjudicated mental
3-9 incompetent;
3-10 (20) to not be discharged from the institution except
3-11 as provided in the standards adopted by the department under
3-12 Section 242.403; [and]
3-13 (21) to be free from any physical or chemical
3-14 restraints imposed for the purposes of discipline or convenience,
3-15 and not required to treat the resident's medical symptoms; and
3-16 (22) to receive information about prescribed
3-17 psychoactive medication from the person prescribing the medication
3-18 or that person's designee, to have any psychoactive medications
3-19 prescribed and administered in a responsible manner, as mandated by
3-20 Section 242.505, and to refuse to consent to the prescription of
3-21 psychoactive medications.
3-22 SECTION 2. Subchapter L, Chapter 242, Health and Safety
3-23 Code, is amended by adding Section 242.505 to read as follows:
3-24 Sec. 242.505. PRESCRIPTION OF PSYCHOACTIVE MEDICATION.
3-25 (a) In this section:
3-26 (1) "Medication-related emergency" means a situation
4-1 in which it is immediately necessary to administer medication to a
4-2 resident to prevent:
4-3 (A) imminent probable death or substantial
4-4 bodily harm to the resident; or
4-5 (B) imminent physical or emotional harm to
4-6 another because of threats, attempts, or other acts the resident
4-7 overtly or continually makes or commits.
4-8 (2) "Psychoactive medication" means a medication that
4-9 is prescribed for the treatment of symptoms of psychosis or other
4-10 severe mental or emotional disorders and that is used to exercise
4-11 an effect on the central nervous system to influence and modify
4-12 behavior, cognition, or affective state when treating the symptoms
4-13 of mental illness. The term includes the following categories when
4-14 used as described by this subdivision:
4-15 (A) antipsychotics or neuroleptics;
4-16 (B) antidepressants;
4-17 (C) agents for control of mania or depression;
4-18 (D) antianxiety agents;
4-19 (E) sedatives, hypnotics, or other
4-20 sleep-promoting drugs; and
4-21 (F) psychomotor stimulants.
4-22 (b) A person may not administer a psychoactive medication to
4-23 a resident who does not consent to the prescription unless:
4-24 (1) the resident is having a medication-related
4-25 emergency; or
4-26 (2) the person authorized by law to consent on behalf
5-1 of the resident has consented to the prescription.
5-2 (c) Consent to the prescription of psychoactive medication
5-3 given by a resident or by a person authorized by law to consent on
5-4 behalf of the resident is valid only if:
5-5 (1) the consent is given voluntarily and without
5-6 coercive or undue influence;
5-7 (2) the person prescribing the medication or that
5-8 person's designee provided the following information, in a standard
5-9 format approved by the department, to the resident and, if
5-10 applicable, to the person authorized by law to consent on behalf of
5-11 the resident:
5-12 (A) the specific condition to be treated;
5-13 (B) the beneficial effects on that condition
5-14 expected from the medication;
5-15 (C) the probable clinically significant side
5-16 effects and risks associated with the medication; and
5-17 (D) the proposed course of the medication;
5-18 (3) the resident and, if appropriate, the person
5-19 authorized by law to consent on behalf of the resident are informed
5-20 in writing that consent may be revoked; and
5-21 (4) the consent is evidenced in the resident's
5-22 clinical record by a signed form prescribed by the facility or by a
5-23 statement of the person prescribing the medication or that person's
5-24 designee that documents that consent was given by the appropriate
5-25 person and the circumstances under which the consent was obtained.
5-26 (d) A resident's refusal to consent to receive psychoactive
6-1 medication shall be documented in the resident's clinical record.
6-2 (e) If a person prescribes psychoactive medication to a
6-3 resident without the resident's consent because the resident is
6-4 having a medication-related emergency:
6-5 (1) the person shall document in the resident's
6-6 clinical record in specific medical or behavioral terms the
6-7 necessity of the order; and
6-8 (2) treatment of the resident with the psychoactive
6-9 medication shall be provided in the manner, consistent with
6-10 clinically appropriate medical care, least restrictive of the
6-11 resident's personal liberty.
6-12 (f) A physician or a person designated by the physician is
6-13 not liable for civil damages or an administrative penalty and is
6-14 not subject to disciplinary action for a breach of confidentiality
6-15 of medical information for a disclosure of the information provided
6-16 under Subsection (c)(2) made by the resident or the person
6-17 authorized by law to consent on behalf of the resident that occurs
6-18 while the information is in the possession or control of the
6-19 resident or the person authorized by law to consent on behalf of
6-20 the resident.
6-21 SECTION 3. This Act takes effect immediately if it receives
6-22 a vote of two-thirds of all the members elected to each house, as
6-23 provided by Section 39, Article III, Texas Constitution. If this
6-24 Act does not receive the vote necessary for immediate effect, this
6-25 Act takes effect September 1, 2001.
_______________________________ _______________________________
President of the Senate Speaker of the House
I hereby certify that S.B. No. 355 passed the Senate on
April 11, 2001, by the following vote: Yeas 29, Nays 0, one
present, not voting; and that the Senate concurred in House
amendments on May 24, 2001, by the following vote: Yeas 30,
Nays 0, one present, not voting.
_______________________________
Secretary of the Senate
I hereby certify that S.B. No. 355 passed the House, with
amendments, on May 16, 2001, by the following vote: Yeas 140,
Nays 0, two present, not voting.
_______________________________
Chief Clerk of the House
Approved:
_______________________________
Date
_______________________________
Governor