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.
 1-5           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:
3-25     (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