By Lindsay S.B. No. 355
77R4512 JAT-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to a nursing home resident's right to informed consent
1-3 regarding the administration of certain drugs.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Section 242.501(a), Health and Safety Code, is
1-6 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;
2-1 (7) to have information about the resident in the
2-2 possession of the institution maintained as confidential;
2-3 (8) to retain the services of a physician the resident
2-4 chooses, at the resident's own expense or through a health care
2-5 plan, and to have a physician explain to the resident, in language
2-6 that the resident understands, the resident's complete medical
2-7 condition, the recommended treatment, and the expected results of
2-8 the treatment, including any expected effects, clinically possible
2-9 side effects, and risks associated with psychoactive medications;
2-10 (9) to participate in developing a plan of care, to
2-11 refuse treatment, and to refuse to participate in experimental
2-12 research;
2-13 (10) to a written statement or admission agreement
2-14 describing the services provided by the institution and the related
2-15 charges;
2-16 (11) to manage the resident's own finances or to
2-17 delegate that responsibility to another person;
2-18 (12) to access money and property that the resident
2-19 has deposited with the institution and to an accounting of the
2-20 resident's money and property that are deposited with the
2-21 institution and of all financial transactions made with or on
2-22 behalf of the resident;
2-23 (13) to keep and use personal property, secure from
2-24 theft or loss;
2-25 (14) to not be relocated within the institution,
2-26 except in accordance with standards adopted by the department under
2-27 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 a treating physician and pharmacist,
3-18 to have any psychoactive medications prescribed and administered in
3-19 a responsible manner, as mandated by Section 242.505, and to refuse
3-20 to consent to the administration of psychoactive medications.
3-21 SECTION 2. Subchapter L, Chapter 242, Health and Safety
3-22 Code, is amended by adding Section 242.505 to read as follows:
3-23 Sec. 242.505. ADMINISTRATION OF PSYCHOACTIVE MEDICATION. (a)
3-24 In this section:
3-25 (1) "Medication-related emergency" means a situation
3-26 in which it is immediately necessary to administer medication to a
3-27 resident to prevent:
4-1 (A) imminent probable death or substantial
4-2 bodily harm to the resident; or
4-3 (B) imminent physical or emotional harm to
4-4 another because of threats, attempts, or other acts the resident
4-5 overtly or continually makes or commits.
4-6 (2) "Psychoactive medication" means a medication
4-7 prescribed for the treatment of symptoms of psychosis or other
4-8 severe mental or emotional disorders and that is used to exercise
4-9 an effect on the central nervous system to influence and modify
4-10 behavior, cognition, or affective state when treating the symptoms
4-11 of mental illness. The term includes the following categories when
4-12 used as described by this subdivision:
4-13 (A) antipsychotics or neuroleptics;
4-14 (B) antidepressants;
4-15 (C) agents for control of mania or depression;
4-16 (D) antianxiety agents;
4-17 (E) sedatives, hypnotics, or other
4-18 sleep-promoting drugs; and
4-19 (F) psychomotor stimulants.
4-20 (b) A person may not administer a psychoactive medication to
4-21 a resident who does not consent to the administration unless:
4-22 (1) the resident is having a medication-related
4-23 emergency; or
4-24 (2) the resident's representative authorized by law to
4-25 consent on behalf of the resident has consented to the
4-26 administration.
4-27 (c) Consent to the administration of psychoactive medication
5-1 given by a resident or by a person authorized by law to consent on
5-2 behalf of the resident is valid only if:
5-3 (1) the consent is given voluntarily and without
5-4 coercive or undue influence;
5-5 (2) the treating physician or a person designated by
5-6 the physician provided the following information, in a standard
5-7 format approved by the department, to the resident and, if
5-8 applicable, to the resident's representative authorized by law to
5-9 consent on behalf of the resident:
5-10 (A) the specific condition to be treated;
5-11 (B) the beneficial effects on that condition
5-12 expected from the medication;
5-13 (C) the probable health and mental health
5-14 consequences of not consenting to the medication;
5-15 (D) the probable clinically significant side
5-16 effects and risks associated with the medication;
5-17 (E) the generally accepted alternatives to the
5-18 medication, if any, and why the physician recommends that they be
5-19 rejected; and
5-20 (F) the proposed course of the medication;
5-21 (3) the resident and, if appropriate, the resident's
5-22 representative authorized by law to consent on behalf of the
5-23 resident are informed in writing that consent may be revoked; and
5-24 (4) the consent is evidenced in the resident's
5-25 clinical record by a signed form prescribed by the facility or by a
5-26 statement of the treating physician or a person designated by the
5-27 physician that documents that consent was given by the appropriate
6-1 person and the circumstances under which the consent was obtained.
6-2 (d) If the treating physician designates another person to
6-3 provide the information under Subsection (c), not later than two
6-4 working days after that person provides the information, excluding
6-5 weekends and legal holidays, the physician shall meet with the
6-6 resident and, if appropriate, the resident's representative who
6-7 provided the consent, to review the information and answer any
6-8 questions.
6-9 (e) A resident's refusal to consent to receive psychoactive
6-10 medication shall be documented in the resident's clinical record.
6-11 (f) In prescribing psychoactive medication, a treating
6-12 physician shall:
6-13 (1) prescribe, consistent with clinically appropriate
6-14 medical care, the medication that has the fewest side effects or
6-15 the least potential for adverse side effects, unless the class of
6-16 medication has been demonstrated or justified not to be effective
6-17 clinically; and
6-18 (2) administer the smallest therapeutically acceptable
6-19 dosages of medication for the resident's condition.
6-20 (g) If a physician issues an order to administer
6-21 psychoactive medication to a resident without the resident's
6-22 consent because the resident is having a medication-related
6-23 emergency:
6-24 (1) the physician shall document in the resident's
6-25 clinical record in specific medical or behavioral terms the
6-26 necessity of the order and that the physician has evaluated but
6-27 rejected other generally accepted, less intrusive forms of
7-1 treatment, if any; and
7-2 (2) treatment of the resident with the psychoactive
7-3 medication shall be provided in the manner, consistent with
7-4 clinically appropriate medical care, least restrictive of the
7-5 resident's personal liberty.
7-6 SECTION 3. This Act takes effect immediately if it receives
7-7 a vote of two-thirds of all the members elected to each house, as
7-8 provided by Section 39, Article III, Texas Constitution. If this
7-9 Act does not receive the vote necessary for immediate effect, this
7-10 Act takes effect September 1, 2001.